Another side effect of ticagrelor: Atrial fibrillation

Zhang, Nixiao; Chen, Kang Yin; Zhao, Jianping; Xu, Gang; Li, Guangping; Liu, Tong

doi:10.1016/j.ijcard.2016.03.091

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…Furthermore, patients with atrial infarction criteria on ECG were excluded from the study to reduce the possible confounding effects of atrial ischemia [19]. Apart from the normal course of ACS, there is a case report indicating that ticagrelor, which increases plasma concentration of adenosine, may cause AF [18]. PLATO trial and some case reports have shown that ticagrelor causes bradyarrhythmias, such as atrioventricular block and sinus node pause [3,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Besides some positive effects, it is also known that adenosine has the potential to cause atrial fibrillation (AF) [15][16][17]. In addition, there is a case report in the literature suggesting that ticagrelor could cause AF, a possible mechanism of which is increased plasma adenosine level [18]. However, there are no studies in the literature investigating the risk of AF in patients treated with ticagrelor.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Algül¹,

Sunman²,

Dural³

et al. 2019

Turk J Med Sci

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Background/aim: Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that specifically increases the plasma level of adenosine, which is likely to cause atrial fibrillation (AF). Therefore, in this study we aimed to investigate the electrocardiographic and echocardiographic predictors of AF development after P2Y12 receptor antagonists in ACS patients. Materials and methods:This cross-sectional study included 831 patients with ACS (486 [58.5%] with ST elevated myocardial infarction [STEMI] and 345 [41.5%] with non-ST elevated myocardial infarction [NSTEMI]). Patients were divided into ticagrelor (n = 410) and clopidogrel (n = 421) groups. P wave properties including P wave dispersion and atrial electromechanical conduction properties were measured as AF predictors with surface ECG and tissue Doppler imaging.Results: Baseline characteristics such as age, sex, heart rate, blood pressure, and laboratory parameters were almost the same in the ticagrelor and clopidogrel groups. The statistical analysis showed no significant difference in P wave dispersion (PWD) between ticagrelor and clopidogrel groups (40.98 ± 12 ms versus 40.06 ± 12 ms, P = 0.304). Subgroups analysis according to ACS types also showed no significant difference in PWD (NSTEMI: 41.16 ± 13.8 ms versus 40.76 ± 13.55 ms, P = 0.799; STEMI: 40.9 ± 12.62 ms versus 39.19 ± 11.18 ms, P = 0.132). In addition, we did not find significant difference in atrial electromechanical delay (EMD) with tissue Doppler imaging (interatrial EMD 24.11 ± 3.06 ms versus 24.46 ± 3.23 ms, P = 0.279). Conclusion:In conclusion, we did not find any difference in detailed electrocardiographic and echocardiographic parameters as AF predictors between ticagrelor and clopidogrel groups in patients with ACS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Algül¹,

Sunman²,

Dural³

et al. 2019

Turk J Med Sci

View full text Add to dashboard Cite

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“…The mean age of patients was 57.5 years, with 100% being male, except for one case, whose age and gender were not mentioned [10]. All patients developed various degrees of AVB and sinusal arrest or ventricular pause [5-12], except for one case who developed atrial fibrillation (AF) [13]. Of nine patients, six had pre-existing AV conduction disorder, eight were on AV blocking agents.…”

Section: Discussionmentioning

confidence: 99%

“…The another data supporting this hypothesis is that ticagrelor may give rise to AF. Zhang et al reported a patient with unstable angina and a history of paroxysmal AF who developed recurrent AF following ticagrelor use, and speculated that ticagrelor might provoke dormant pulmonary vein conduction and AF reccurence via increasing the levels of adenosin [12]. …”

Section: Discussionmentioning

confidence: 99%

Ticagrelor-Associated Conduction Disorder: A Case Report and Review of the Literature

Yurtdaş

Özdemir²

2017

Cardiol Res

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A 47-year-old female presented to emergency clinic due to non-ST-elevation myocardial infarction (NSTEMI). After receiving acetylsalicylic acid, a loading dose of ticagrelor 180 mg and intravenous unfractionated heparin, she underwent successful placement of drug eluting stent on the distal part of non-dominant left circumflex artery. The patient had no pre-existing atrioventricular (AV) block and did not use AV blocking agent. Approximately 10 h after taking a loading dose of ticagrelor, baseline normal rhythm degenerated to the first and then complete AV block, with mild dizziness. Following cessation of ticagrelor, cardiac rhythm returned to normal level within 2 days. The close monitoring of patients after starting ticagrelor is imperative, so ticagrelor may result in advanced conduction disorders. Here, we report a patient who developed various types of AV block associated with the ticagrelor taken during successful percutaneous coronary intervention for NSTEMI. We also reviewed the literature on the association between ticagrelor use and conduction abnormalities.

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“…It found ventricular pauses that lasted at least 3 s occurred more frequently with ticagrelor (5.8%) compared with clopidogrel (3.6%; P = 0.006) during the first week of therapy [100]. There have been many reports of adverse reactions, such as atrial fibrillation and atrioventricular block caused by ticagrelor use [101,102]. The increase in plasma adenosine concentration caused by ticagrelor can be seen as an explanation for the patient bradycardia, but adenosine mainly affects the conduction of the atrioventricular, and the effect caused by ticagrelor comes mostly from the sinus node; another speculation about the proposed mechanism Ticagrelor causes an increase in uric acid levels PLATO Research [2] had shown that the serum uric acid level among patients given ticagrelor was higher than those given clopidogrel.…”

Section: Bradycardia Caused By Ticagrelormentioning

confidence: 99%

A review of the effects of ticagrelor on adenosine concentration and its clinical significance

Akkaif

Kader

et al. 2021

Pharmacol. Rep

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Background Ticagrelor is an oral antiplatelet drug that can reversibly bind to the platelet P2Y12 receptor. Ticagrelor is metabolized mainly by CYP3A4 and produces a rapid blood concentration-dependent platelet inhibitory effect. Unlike other P2Y12 receptor antagonists, many clinical features of ticagrelor are not related to P2Y12 receptor antagonism. Purpose This review aims to gather existing literature on the clinical effects of ticagrelor after inhibiting adenosine uptake. Methodology The current study reviewed literature related to the effects of ticagrelor on adenosine metabolism. The review also examined the drug's biological effects and clinical characteristics to see how it could be used in a clinical setting. Results Many studies have shown that ticagrelor can inhibit equilibrative nucleoside transporter 1 (ENT1). This inhibition leads to intracellular adenosine uptake, increased adenosine half-life and plasma concentration levels and an enhanced adenosine-mediated biological effect. Conclusions Based on the studies reviewed, it was found that ticagrelor essentially inhibits adenosine absorption of adenosine into cells through ENT1, which increases the concentration in the blood and subsequently increases the protection of the heart muscle by adenosine. It also prevents platelet aggregation, and extends the biological effects of coronary arteries. Moreover, it leads to a lower mortality rate in acute coronary syndrome (ACS) patients.

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Another side effect of ticagrelor: Atrial fibrillation

Cited by 8 publications

References 17 publications

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Ticagrelor-Associated Conduction Disorder: A Case Report and Review of the Literature

A review of the effects of ticagrelor on adenosine concentration and its clinical significance

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