Successful Reversal of Bradycardia and Dyspnea With Aminophylline After Ticagrelor Load

Abstract

A 69-year-old male underwent elective percutaneous coronary intervention requiring placement of a drug-eluting stent to the first obtuse marginal artery. Four hours following the administration of a ticagrelor loading dose, he developed dyspnea and sinus pauses. Aminophylline was administered and resulted in immediate and sustained symptom resolution. Ticagrelor has been associated with dyspnea and bradyarrhythmias, both attributed to increased adenosine exposure. Ticagrelor inhibits reuptake of intracellular adenosine. Adenosine antagonists aminophylline and theophylline have been utilized to reverse the effects of adenosine and may relieve adenosine-mediated adverse effects induced by ticagrelor therapy. Aminophylline may be considered for reversal of dyspnea and bradyarrhythmia associated with ticagrelor therapy through alterations in adenosine exposure.

A rare case of late-onset ticagrelor-induced sinus arrest

“…Ticagrelor-induced bradycardia and its reversal has been reported in several case reports. [5][6][7][8] In the PLATO trial, ventricular pauses of more than 3 s and more than 5 s were noted in 5.8% and 2.0% of patients, respectively, in first week. After one month, 2.1% and 0.8% of patients developed ventricular pauses >3 s and >5 s, respectively.…”

Ticagrelor-Related Severe Dyspnoea: Mechanisms, Characteristic Features, Differential Diagnosis and Treatment

“…Based on published case reports theophylline infusions may have positive effect on those symptoms, causing their remission. 41 Our experiences with the drug are similar, but there is a need for evidence from clinical trials. 42 As in none of the clinical trials using ticagrelor, patients were treated with theophylline or other methylxanthine drugs, currently there is no recommendation on this aspect neither by European Medicines Agency nor Food and Drug Administration.…”

Ticagrelor – toward more efficient platelet inhibition and beyond

“…Noteworthy, in one case report both bradycardia and dyspnea were reversed using aminophylline, suggesting that administration of aminophylline might counteract the adenosine-related adverse effects of ticagrelor. 74 …”