Ticagrelor-Induced Angioedema: A Rare and Unexpected Phenomenon

Seecheran, Rajeev; Seecheran, Valmiki; Persad, Sangeeta; Lalla, Sasha; Seecheran, Naveen

doi:10.1155/2017/7612713

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…The drug information portal (U.S National Library of Medicine) has a record of 34 cases, reported as side effects of rashes by the U.S Food and Drug Administration. Out of the two cases reported, angioedema usually occurred within 72 hours of exposure, and the same was the case with our patient [ 13 , 15 ]. Ticagrelor hypersensitivity can be either immediate type or delayed type.…”

Section: Discussionsupporting

confidence: 85%

“…Drug-induced angioedema is estimated to be less than 1% and is usually observed with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Accumulation of bradykinin is implicated as the major contributor to the pathophysiology of angioedema [ 15 ]. Hypersensitivity reactions, in the form of rashes, to ticagrelor are rare (>1/1000, <1/100) and have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Hypersensitivity reactions have been reported in 6% of patients with clopidogrel usage, 1.5% of whom require discontinuation [ 9 ]. To our knowledge, only six cases of ticagrelor hypersensitivity have been reported to date [ 10 - 15 ]. Reporting rare adverse drug reactions to pharmacovigilance databases enables health care providers to access such data when needed [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Ticagrelor-induced Angioedema After Percutaneous Coronary Intervention in a Patient with a History of Ischemic Stroke and Low Response to Clopidogrel: A Rare Dilemma

Piranavan¹,

Kaur²,

Marmoush³

et al. 2018

Cureus

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Dual antiplatelet therapy (DAPT) is widely recognized as the mainstay of treatment after percutaneous coronary intervention (PCI). Premature discontinuation may pose a risk of in-stent thrombosis, acute myocardial infarction, and death. With the increased usage of antiplatelet agents, increased attention has been drawn to their potential allergic reactions.A 66-year-old male with a history of coronary artery disease and ischemic stroke was admitted with worsening severity angina for cardiac catheterization. He was on dual antiplatelet agents, clopidogrel, and aspirin prior to admission. He had PCI and a drug-eluting stent deployment to the culprit vessel. Due to low responsiveness to clopidogrel, he was started on ticagrelor, as prasugrel was contraindicated due to the history of ischemic stroke. A few hours after ticagrelor initiation, he developed shortness of breath, swelling of the throat and tongue, and was diagnosed with angioedema. He didn't have any prior reported history of allergy to any medications to the contrast medium or heparin. The offending medication, ticagrelor, was discontinued. He was managed with intravenous steroids and antihistamines. After the resolution of angioedema, he was discharged with double the dose of clopidogrel in addition to aspirin. The patient did not have any ischemic symptoms or coronary events for the following six-month period of follow-up.The case highlights a relatively rare side effect of ticagrelor. Health care providers should be vigilant about the angioedema following ticagrelor administration. In our patient, it was effectively managed by discontinuing the offending medication and the administration of steroids and histamine blockers. The recovery was prompt, without any serious untoward effects. The DAPT was changed to clopidogrel, double the conventional dose, in addition to aspirin.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ticagrelor-induced Angioedema After Percutaneous Coronary Intervention in a Patient with a History of Ischemic Stroke and Low Response to Clopidogrel: A Rare Dilemma

Piranavan¹,

Kaur²,

Marmoush³

et al. 2018

Cureus

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“…In our review of the literature there have been only 2 published cases implicating Ticagrelor as the underlying cause of angioedema. 8,9 In both cases, angioedema occurred within 72 hours of exposure, as was the case for the patient described here.…”

Section: Discussionsupporting

confidence: 72%

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Elmashad

Emmerson

Gorseth

et al. 2022

The Neurohospitalist

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Ticagrelor is a frequent component of dual antiplatelet therapy (DAPT) following carotid artery stent placement. Hemorrhagic complications remain the focus of most reports, however, other adverse events must also be known to the prescribing physician. Angioedema is a rare and potentially life-threatening complication reported following ticagrelor administration and we present 1 such case here with a review of the existing literature.

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“…Table 1 summarizes the clinical features of these patients. 5–11 All 7 patients were male who were 44–73 years of age; 4 presented with acute coronary syndrome, whereas 2 had stable angina, and 5 of 6 patients in the case reports had undergone a PCI with a drug-eluting stent. Hypersensitivity manifestations included rash (n = 4), urticaria (n = 1), angioedema (n = 2), periorbital edema (n = 1), and hemorrhagic bullae (n = 2).…”

mentioning

confidence: 99%