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Ticagrelor-induced life-threatening bleeding via the cyclosporine-mediated drug interaction: A case report

Chi Zhang1, Long Shen, Min Cui

  • 1Department of Pharmacy Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Medicine
|September 15, 2017
PubMed

Insights

Ticagrelor can cause severe bleeding in transplant patients due to drug interactions with cyclosporine. This case highlights the risk of drug-drug interactions with P2Y12 receptor antagonists in vulnerable populations.

Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Transplantation

Background:

  • Ticagrelor is a first-line antiplatelet agent for acute coronary syndrome (ACS).
  • Bleeding is a significant adverse reaction associated with ticagrelor therapy.
  • Cyclosporine is an immunosuppressant commonly used in transplant recipients.

Observation:

  • A 58-year-old male, post-renal transplant and on cyclosporine, developed ACS.
  • Ticagrelor was initiated for ACS treatment.
  • The patient experienced severe gum bleeding and bloody stools, indicative of a life-threatening event.

Findings:

  • The patient's symptoms resolved after discontinuing ticagrelor and switching to clopidogrel.
  • Supportive care included proton pump inhibitors, hemocoagulase, and blood product transfusions.
  • This suggests a potential ticagrelor-cyclosporine drug-drug interaction.

Implications:

  • Drug-drug interactions (DDIs) can lead to severe adverse events, particularly in transplant patients.
  • Careful consideration of antiplatelet therapy is crucial in patients on concomitant medications like cyclosporine.
  • Optimizing P2Y12 receptor antagonist use is essential for safety and efficacy in fragile patient populations.
Abstract

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