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A rare but serious complication of ticagrelor therapy: a case report
Manfredi Arioti1, Giovanni Sirianni1, Maria Luisa Laudisa1
1Dipartimento di Cardiologia, Policlinico San Marco, Zingonia, Gruppo San Donato.
Insights
Ticagrelor, a P2Y12 inhibitor, can cause significant brady-arrhythmic events, including asystole, despite previous reports of trivial clinical significance. This case highlights the potential for serious cardiac events linked to ticagrelor use in acute coronary syndrome patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Ticagrelor is a P2Y12 inhibitor crucial for acute coronary syndrome (ACS) and post-percutaneous coronary intervention (PCI).
- Common side effects include dyspnoea and bradycardia, often considered clinically insignificant.
Background:
Ticagrelor is a widely used P2Y12 inhibitor and represents a fundamental therapeutic agent in acute coronary syndrome treatment and selected post-percutaneous coronary intervention (PCI) cases. Dyspnoea and bradycardia are the most common side effects but the latter has been reported to be of trivial clinical significance.
Case Summary:
A 51-year-old gentleman underwent PCI to left anterior descending and obtuse marginal for unstable angina receiving a loading dose of ticagrelor (180 mg). During hospital stay, whilst on telemetry monitoring, a 16 s long, symptomatic, asystolic ventricular standstill was recorded prompting ticagrelor interruption and a switch to prasugrel.
Discussion:
Despite ventricular pauses have been reported in dedicated analyses of Phase III trials, no apparent clinical consequences were documented. However, several reports have shown that significant brady-arrhythmic events might be linked to ticagrelor administration presenting both as sino-atrial and atrio-ventricular conduction disturbances. We report a case of asystole occurring 36 h after the administration of a loading dose.
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