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An interesting case series of ticagrelor induced long QTc
Alireza Farzaei1, Entezar Mehrabi Nasab2,3, Yaser Jenab1
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran.
Insights
Ticagrelor may cause prolonged QT intervals in patients undergoing percutaneous coronary intervention. Switching to Clopidogrel resolved the issue, highlighting a potential Ticagrelor side effect needing clinical awareness.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Ticagrelor is an antiplatelet medication frequently used post-PCI.
Observation:
- Three patients developed prolonged QTc intervals on electrocardiograms (ECGs) while on Ticagrelor therapy post-PCI.
- These QTc interval prolongations resolved upon switching to Clopidogrel.
Findings:
- This case series suggests a potential association between Ticagrelor use and QTc interval prolongation.
- A proposed mechanism involves Ticagrelor blocking adenosine uptake by red blood cells.
Implications:
- Clinicians should be aware of Ticagrelor's potential to prolong QTc intervals, a previously unlisted side effect.
- Close patient monitoring and consideration of alternative antiplatelet agents like Clopidogrel are recommended.
Abstract:
This case series explores three patients who underwent percutaneous coronary intervention (PCI) and experienced prolonged QT intervals under treatment with Ticagrelor. The first case was a female who presented with chest pain and received a Xience stent. The second case involved a male patient who received two Xience stents. The third case was that of a male patient with LAD stenosis. All three patients received Ticagrelor and exhibited prolonged QTc intervals on their electrocardiograms (ECGs), which was resolved after switching to Clopidogrel. Thus far, the potential impact of Ticagrelor on QT prolongation has not been adequately addressed in the literature. It is hypothesized that Ticagrelor can block adenosine uptake by red blood cells, which may explain QTc prolongation. The results of this case series indicate that Ticagrelor may prolong QTc intervals. Consequently, it is imperative that clinicians are aware of this previously unlisted side effect and that patients are closely monitored while seeking alternative medications to manage the condition.
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