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Ticagrelor and bradycardia: a nested case-control study

Ricky D Turgeon1, Kimberly A Fernandes2, David Juurlink2,3

  • 1Department of Pharmacy, Vancouver General Hospital, Vancouver, BC, Canada.

Pharmacoepidemiology and Drug Safety
|October 9, 2015
PubMed

Insights

Ticagrelor use was not linked to increased bradycardia hospitalizations in older acute coronary syndrome patients compared to clopidogrel. This real-world study found no significant association between ticagrelor and bradycardia risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Real-world evidence studies

Background:

  • Ticagrelor is known to increase adenosine levels, potentially slowing cardiac conduction and causing bradycardia.
  • Clinical trials and case reports suggest a possible link between ticagrelor and bradyarrhythmias, necessitating further investigation.

Purpose of the Study:

  • To investigate the association between ticagrelor use and hospitalization for bradycardia in older adults following an acute coronary syndrome.
  • To compare the risk of bradycardia hospitalization with ticagrelor versus clopidogrel in a real-world setting.

Main Methods:

  • A population-based, nested case-control study was conducted using Ontario healthcare databases.
  • Older patients (≥66 years) hospitalized for bradycardia after an acute coronary syndrome were identified as cases.
  • Each case was matched with four controls who were also prescribed a P2Y12 inhibitor, with ticagrelor exposure assessed within 90 days prior to the index date.

Main Results:

  • The study included 140 cases and 560 controls between April 2012 and March 2014.
  • No statistically significant association was found between ticagrelor use and hospitalization for bradycardia compared to clopidogrel (adjusted odds ratio: 1.06, 95% CI: 0.65-2.21).
  • Adjustments for potential confounders did not alter the finding of no significant association.

Conclusions:

  • In older patients with a first acute coronary syndrome, ticagrelor use was not associated with an increased risk of bradycardia hospitalization compared to clopidogrel.
  • These real-world findings suggest that ticagrelor can be used safely in this patient population regarding bradycardia risk.
Abstract

Keywords:
acute coronary syndromebradycardiaclopidogrelmyocardial infarctionp2y12 inhibitorpharmacoepidemiologyticagrelor

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