Practical experience with ticagrelor: an Australian and New Zealand perspective

Abstract

When switching from clopidogrel to ticagrelor, patients established on clopidogrel therapy can be switched directly without loading; patients not loaded with clopidogrel and not taking maintenance dose clopidogrel for at least 5 days should first be loaded with ticagrelor. Guidelines recommend discontinuing ticagrelor 5 days before surgery if antiplatelet effects are not desired and recommencing therapy as soon as safe following surgery. Ticagrelor should be avoided in individuals with a history of intracranial hemorrhage, moderate-to-severe hepatic impairment, high bleeding risk, within 24 hours of thrombolytic therapy, and in those treated with oral anticoagulants. Local, real-world experience suggests low bleeding rates with ticagrelor therapy. Dyspnoea is a common symptom in patients with ACS and is also a side-effect of ticagrelor therapy. Discontinuation of ticagrelor due to dyspnoea has been uncommon in clinical trials. However, local registry data suggest higher discontinuation rates (2-9%) related to dyspnoea in the real-world setting, indicating that clinicians may need to consider other potential causes of dyspnoea before discontinuing ticagrelor.

Ticagrelor-related late-onset dyspnea as cause of emergency department visit: a 3-year outpatient study

“…Acute coronary syndromes (ACS), which include unstable angina, non-ST-elevation myocardial infarction and STelevation myocardial infarction are life-threatening disorders, and a source of high morbidity and mortality. 1,2 Dual antiplatelet therapy with low-dose aspirin (acetylsalicylic acid) and P2Y 12 receptor antagonists (i.e. clopidogrel, prasugrel, or ticagrelor) is standard postdischarge therapy after ACS for secondary prevention of vascular events.…”

Copper-Catalyzed Asymmetric Hydrosilylation of β-Nitroethyl Aryl Ketones

“…trans -2-Arylcyclopropylamine derivatives are widely found in many bioactive compounds or drugs including Tranylcypromine, Ticagrelor, Antiallergic compounds, LSD1 (lysine demethylase 1) inhibitors, and so on (Figure ). Tranylcypromine is a nonselective and irreversible inhibitor of the enzyme monoamine oxidase, and it is used as an antidepressant and anxiolytic agent in the clinical treatment of mood and anxiety disorders, respectively.…”

Ticagrelor – toward more efficient platelet inhibition and beyond

“…Occurrence of dyspnea varies among trials and depends mainly on the length of administration and dosage of ticagrelor. For example, dyspnea was the reason for ticagrelor discontinuation in 2%–9% ACS patients, 68 whereas dyspnea was not observed in healthy elderly volunteers and mild asthma or mild-to-moderate COPD patients. 65 The lack of dyspnea in the latter study was probably due to short duration of the trial.…”