Ticagrelor-related dyspnea: An underestimated and poorly managed event?

Lombardi, Niccolò; Lenti, Maria Carmela; Matucci, Rosanna; Mugelli, Alessandro; Vannacci, Alfredo

doi:10.1016/j.ijcard.2014.11.054

Cited by 11 publications

(6 citation statements)

References 6 publications

(6 reference statements)

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“…Early-onset dyspnea related to ticagrelor is typically not caused by heart dysfunctions, usually occurs within the 1st days of treatment and it was traditionally attributed to drug's adenosine-mediated actions, as ticagrelor has a chemical structure similar to that of adenosine. 26 However, given that dyspnea is an adverse event also observed for other antiplatelet reversible agents (i.e. elinogrel), with a different chemical structure compared with adenosine molecule, alternative hypotheses were formulated.…”

Section: Discussionmentioning

confidence: 99%

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

Lombardi¹,

Lucenteforte²,

Torrini

et al. 2018

Journal of Cardiovascular Medicine

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Section: Discussionmentioning

confidence: 99%

“…Anyway, given the benefits provided by the drug in this subset of patients, we believe that prescribers should consider ticagrelor replacement only in patients who cannot tolerate dyspnea. 26…”

Section: Discussionmentioning

confidence: 99%

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

Lombardi¹,

Lucenteforte²,

Torrini

et al. 2018

Journal of Cardiovascular Medicine

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“…15 Symptom resolution reportedly occurs after ticagrelor discontinuation, and no underlying pathologic cardiac or pulmonary abnormalities have been identified. [16][17][18] A substudy of patients in the PLATO trial underwent Holter monitoring for 6 days following initiation of treatment. Ventricular pauses lasting !3 seconds occurred in 5.8% of patients in the ticagrelor group versus 3.6% in the clopidogrel group (P ¼ .006).…”

Section: Discussionmentioning

confidence: 99%

“…15 Symptom resolution reportedly occurs after ticagrelor discontinuation, and no underlying pathologic cardiac or pulmonary abnormalities have been identified. 16 –18…”

Section: Discussionmentioning

confidence: 99%

Successful Reversal of Bradycardia and Dyspnea With Aminophylline After Ticagrelor Load

Minner

Simone

Chung

et al. 2016

Journal of Pharmacy Practice

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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.

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“…Antiplatelet drugs are those drugs which prevents the blood platelets from sticking together and forming a blood clot. DAPT is important for preventing stent thrombosis and also the recurrence of ACS events [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Dyspnea in Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Patients on Dual Antiplatelets in a Tertiary Care Hospital in South India

Krishnan¹,

Mohan²,

Jom³

et al. 2015

Cardiovasc Pharm Open Access

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Background: For post Percutaneous Transluminal Coronary Angioplasty for Acute Coronary Syndromes, Dual Antiplatelet Therapy with Aspirin and a P2Y12 receptor inhibitor like Ticagrelor or Clopidogrel is required minimum for a period of 12 months. There are few studies which have shown the incidence of dyspnea in patients receiving antiplatelet therapy. Methods: In this retrospective, single centre, cohort study, patients who underwent PTCA and were on dual antiplatelets were randomly selected from the clopidogrel and ticagrelor group between July 2013 and June 2014. Patient's relevant data were collected from electronic medical records and cross checked with manually maintained medical records wherever necessary. The study endpoint was incidence of dyspnoea within a follow up period of 9 months. Results: Among the 100 patients started on dual antiplatelet therapy with aspirin and ticagrelor, dyspnea occurred in 10% patients. Ticagrelor was substituted with clopidogrel in 60% cases. In 100 patients on clopidogrel, dyspnea occurred in 5% of patients, but clopidogrel was continued in all cases. Onset of dyspnea in patients on Ticagrelor occurred in 50% of patients in the first month of follow up, 10% cases at 3 months, 30% cases at 6 months and 10% cases at 9 months. But in clopidogrel group dyspnea occurred in 40% cases at 6 months follow up and 60% cases at 9 months. The p value on comparison of dyspnoea among the two groups was found to be 0.283, which was not statistically significant probably due to less sample population. Conclusion: Risk for dyspnoea induced by Ticagrelor was found to be higher than with Clopidogrel in the same ethnic groups when used as dual antiplatelet along with Aspirin. So it may not be a class effect or due to P2Y12 receptor inhibitory action alone.

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Ticagrelor-related dyspnea: An underestimated and poorly managed event?

Cited by 11 publications

References 6 publications

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

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

Successful Reversal of Bradycardia and Dyspnea With Aminophylline After Ticagrelor Load

Dyspnea in Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Patients on Dual Antiplatelets in a Tertiary Care Hospital in South India

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