A Case of Ticagrelor-Induced Sinus Pause.
Nicholas T Pavlatos1, Aangi Shah1, Muhammad Khan2
1Department of Internal Medicine, University of Louisville Hospital, Louisville, USA.
Cureus
|August 14, 2023
Summary
Ticagrelor, an antiplatelet drug, can cause sinus pauses by inhibiting adenosine uptake. This case highlights prolonged sinus pauses occurring hours after ticagrelor initiation post-percutaneous coronary intervention.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Ticagrelor is a widely used oral antiplatelet agent post-percutaneous coronary intervention (PCI).
- Bradyarrhythmias, particularly sinus pauses, have been associated with ticagrelor use.
- The mechanism is hypothesized to involve ticagrelor's inhibition of human equilibrative nucleoside transporter 1 (hENT1), affecting adenosine uptake.
Observation:
- A 58-year-old male presented with prolonged sinus pauses.
- These events occurred 38 hours after initiating ticagrelor.
- The patient had undergone PCI for ST-elevation myocardial infarction.
Findings:
- The case illustrates a delayed onset of ticagrelor-induced bradyarrhythmia.
- This finding supports the link between ticagrelor, hENT1 inhibition, and adenosine levels.
- Prolonged sinus pauses represent a significant adverse cardiac event.
Implications:
- Clinicians should be vigilant for bradyarrhythmias in patients taking ticagrelor, even hours after initiation.
- Understanding the adenosine-related mechanism is crucial for managing ticagrelor-associated cardiac events.
- Further research may explore monitoring adenosine levels or alternative antiplatelet strategies.
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