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

Lombardi, Niccolò; Lucenteforte, Ersilia; Torrini, M.; Balzi, Daniela; Barchielli, Alessandro; Mugelli, Alessandro; Vannacci, Alfredo

doi:10.2459/jcm.0000000000000656

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Three studies among the 11 included studies noted increased risk of dyspnea associated with ticagrelor use. This reiterates dyspnea as one of the acute side effects of ticagrelor which is reported and recognized in previous secondary analysis and cohort studies [27, 28]. However, the chronicity of dyspnea associated with ticagrelor use cannot be established in this analysis due to the limited long-term data.…”

Section: Discussionsupporting

confidence: 57%

Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction: There has been inconsistent data on the direct comparison of prasugrel and ticagrelor. This meta-analysis was conducted to summarise the current available evidence. Methods: We performed a meta-analysis (PROSPERO-registered CRD42020166810) of randomized trials up to Feb 2020 that compared prasugrel and ticagrelor in acute coronary syndrome with respect to the composite endpoint of myocardial infarction (MI), stroke or cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), stent thrombosis, all-cause death and other safety outcomes. Results: Of the 11 eligible RCTs with 6098 patients randomized to prasugrel (n=3050) or ticagrelor (n=3048), 180 and 207 had the composite endpoint events in the prasugrel arm and the ticagrelor arm respectively over a weighted mean follow up period of 11±2 months. Compared with prasugrel, the ticagrelor group had similar risk in the primary composite endpoint (Risk Ratio (RR)= 1.17; 95% CI=0.96-1.42; p=0.12, I2=0%). Compared to prasugrel, there was no significant difference associated with the use of ticagrelor groups with respect to stroke (RR=1.05; 95% CI=0.66-1.67; p=0.84, I2=0%); cardiovascular death (RR=1.01; 95% CI=0.75-1.36; p=0.95, I2=0%); BARC type 2 or above bleeding (RR=1.16; 95% CI =0.89-1.52; p=0.26, I2=0%); stent thrombosis (RR=1.58; 95% CI =0.90-2.76; p=0.11, I2=0%); all cause death (RR=1.10; 95% CI =0.86-1.43; p=0.45, I2=0%) except MI (RR=1.38; 95% CI=1.05-1.81; p=0.02, I2=0%) Conclusion: Compared with prasugrel, ticagrelor did not reduce the primary composite endpoint of MI, stroke and cardiovascular death at a weighted mean follow up of 11 months. There was no significant difference between the secondary outcomes except myocardial infarction.

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Section: Discussionsupporting

confidence: 57%

Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

et al. 2021

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“…In recent years, some case reports and retrospective studies have shown that dyspnea associated with ticagrelor occurs not only in the early stages of drug treatment, but also may cause delayed dyspnea and even more dangerous Cheyne-Stokes (CSR) [6,7,8] . Because of this adverse event, the rate of discontinuation from 0.9-6.5% [9,10] , and one in 20 outpatients receiving a stabilized ticagrelor treatment might develop a dyspnea leading to an emergency room visit [11] .…”

Section: Introductionmentioning

confidence: 99%

“…The exact mechanism of ticagrelor-induced dyspnea remains unclear [11,13] . There are several hypotheses (i)ticagrelor inhibits adenosine reuptake by red blood cell via inhibiting the sodium-independent equilibrative nucleoside transporter-1 (ENT-1).…”

Section: Introductionmentioning

confidence: 99%

Effects of oral administration of ticagrelor on the plasma level of adrenaline, histamine, serotonin, and acetylcholine in rat

Guo

et al. 2020

Preprint

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Background: Ticagrelor as a reversible P2Y12 receptor antagonist which plays an important role in the treatment of acute coronary syndrome (ACS). Dyspnea is one of the main adverse reactions of ticagrelor, however the mechanism is not clearly now. The aim of this study was to assess the possible relationship between ticagrelor-related dyspnea and some neurotransmitter in plasma which can contract the bronchial smooth muscle.Methods: The effects of ticagrelor on the plasma level of adrenaline, histamine, serotonin, and acetylcholine was studied in rats. Ticagrelor was administered at a loading dose of 24 mg/kg for the first time, and then maintenance dose 12 mg/kg, twice a day for 6 days. The plasma level of adrenaline, histamine, serotonin, and acetylcholine was determined by LC-MS/MS.Results: The plasma level of serotonin increased after ticagrelor administrating, especially at 1.5h ( p <0.05) reach the level of statistical significance. The level of serotonin in plasma was consistent with ticagrelor blood concentration. Meanwhile, ticagrelor can cause a decrease in the plasma concentration of histamine, and the change was statistically significant at time points of 1.5h, 3.5h and 10.5h respectively. The concentration of the adrenaline and acetylcholine had no change.Conclusions: The results of this study reveal that ticagrelor can increases blood serotonin levels and this may be a cause of dyspnea ticagrelor-related.

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Pharmacogenetics to guide cardiovascular drug therapy

Duarte

Cavallari

2021

Nat Rev Cardiol

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

Cited by 4 publications

References 29 publications

Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Effects of oral administration of ticagrelor on the plasma level of adrenaline, histamine, serotonin, and acetylcholine in rat

Pharmacogenetics to guide cardiovascular drug therapy

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