Ticagrelor: A Rare, Delayed Case of Angioedema

Area of Science:

• Cardiology
• Pharmacology
• Allergy and Immunology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors is standard for acute coronary syndrome (ACS) and after percutaneous coronary intervention (PCI).
• While clopidogrel is linked to allergic reactions like angioedema, data on ticagrelor hypersensitivity is limited.
• Angioedema is a rare but serious adverse effect of antiplatelet medications.

Observation:

• A case of delayed-onset angioedema occurred three weeks after initiating DAPT with aspirin and ticagrelor post-PCI with drug-eluting stent (DES) placement.
• The patient presented with acute tongue swelling, successfully treated with epinephrine, steroids, and antihistamines.
• Normal C1 esterase inhibitor and tryptase levels were noted, ruling out other causes.

Findings:

• Ticagrelor was discontinued, and the patient was switched to prasugrel for DAPT.
• The patient experienced no recurrence of angioedema symptoms after switching to prasugrel.
• This case highlights a rare instance of delayed-onset ticagrelor-induced angioedema.

Implications:

• Clinicians should be aware of the potential for delayed-onset angioedema with ticagrelor, even weeks after initiation.
• Prompt recognition and management, including drug discontinuation and switching to an alternative P2Y12 inhibitor, are crucial.
• Further research into ticagrelor hypersensitivity reactions is warranted to improve patient safety.