Dyspnoea management in acute coronary syndrome patients treated with ticagrelor

Abstract

The occurrence of dyspnoea in acute coronary syndrome (ACS) patients has always been considered a challenging diagnostic and therapeutic clinical scenario. P2Y12 platelet receptor inhibitors (i.e., clopidogrel, prasugrel and ticagrelor) are currently the cornerstone of treatment of ACS patients. Thus, in the last few years, the potential association between ACS and dyspnoea has also become more challenging with the increasing use of ticagrelor in these patients due to its beneficial effects on ischaemic event prevention and mortality, since ticagrelor can induce dyspnoea as a side effect. The present article is intended to review the current literature regarding dyspnoea occurrence in ACS patients, especially those treated with ticagrelor, and to propose ticagrelor-associated dyspnoea management recommendations based on current knowledge.

Dyspnea related to reversibly-binding P2Y12 inhibitors: A review of the pathophysiology, clinical presentation and diagnostics

“…The timing of onset of dyspnea and its characteristics in relationship to the commencement of treatment with ticagrelor may facilitate confident diagnosis of ticagrelor-related dyspnea in some individuals [125]. Based on the principles outlined above, this can allow the construction of algorithms in order to simplify management of antiplatelet therapy in ticagrelor-treated patients presenting with dyspnea [125].…”

“…Based on the principles outlined above, this can allow the construction of algorithms in order to simplify management of antiplatelet therapy in ticagrelor-treated patients presenting with dyspnea [125].…”

Ticagrelor

“…These data support the use of ticagrelor in HTPR patients with ACS. However, the cost of medication, patient compliance (twice a day doses), possible side effects (although manageable) [27,28], and reversible platelet inhibition [29] should be taken into consideration when using ticagrelor.…”

Antiplatelet therapy – a summary for the general physicians

“…However, if the dyspnoea is troublesome, consider switching to prasugrel (or clopidogrel if prasugrel is contraindicated) with a full loading dose 24 hours from the last ticagrelor dose. 34 …”