Life-threatening complete atrioventricular block associated with ticagrelor therapy

Goldberg, A.; Rosenfeld, Inna; Nordkin, Irena; Halabi, Majdi

doi:10.1016/j.ijcard.2014.12.162

Cited by 28 publications

(18 citation statements)

References 6 publications

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“…14 Future studies with access to detailed inpatient medical records including vital signs may yet identify an increased risk of bradycardia with ticagrelor in this setting.…”

Section: Discussionmentioning

confidence: 99%

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Ticagrelor and bradycardia: a nested case–control study

Turgeon

Fernandes

Juurlink

et al. 2015

Pharmacoepidemiology and Drug

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“…14 Future studies with access to detailed inpatient medical records including vital signs may yet identify an increased risk of bradycardia with ticagrelor in this setting.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 In light of this ongoing uncertainty, we examined the association between ticagrelor use and hospitalization for bradycardia in patients with ACS.…”

Section: Introductionmentioning

confidence: 99%

Ticagrelor and bradycardia: a nested case–control study

Turgeon

Fernandes

Juurlink

et al. 2015

Pharmacoepidemiology and Drug

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“…High-degree AV block occurred in a healthy volunteer after a large dose of the drug in a dose-finding study[1], but it was not considered a serious issue in the normal clinical setting[3]. It is only recently that some reports have described cases of high-degree, life-threatening, AV block requiring drug discontinuation[4-8], in patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

“…The first article was published by Goldberg et al[4] in 2015. A 52-year-old diabetic man with ACS and severe stenosis of ostial left anterior descending (LAD) artery underwent 2 bare metal stents implantation.…”

Section: Case Reportmentioning

confidence: 99%

Ticagrelor therapy and atrioventricular block: Do we need to worry?

Maria¹,

Borghi²,

Modonesi³

et al. 2017

WJCC

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Ticagrelor is a potent, direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition, indicated in patients with acute coronary syndromes (ACS). This drug is usually well tolerated, but some patients experience serious adverse effects: Major bleeding; gastrointestinal disturbances; dyspnoea; ventricular pauses > 3 s. Given the unexpected high incidence of bradyarrhythmias, a PLATO substudy monitored this side effect, showing that ticagrelor was associated with an increase in the rate of sinus bradycardia and sinus arrest compared to clopidogrel. This side effect was usually transient, asymptomatic and not associated with higher incidence of severe atrioventricular (AV) block or pacemaker needs. A panel of experts from Food and Drug Administration did not consider bradyarrhythmias a serious problem in clinical practice and, accordingly, current labeling of the drug does not give any precaution or contraindication regarding this issue. However, recently some articles have described ACS patients with high-degree, life-threatening, AV block requiring drug discontinuation and, in some cases, pacemaker implantation. In this paper, we describe and discuss five published case reports of severe AV block following ticagrelor therapy and two other cases managed in our Hospital. The analysis of literature suggests that, although rarely, ticagrelor can be associated with life-threatening AV block. Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with AV blocking agents. Future studies, with long-term rhythm monitoring, would help to define the outcome of patients at higher risk of developing this complication.

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“…However, some adverse effects may occur [3][4][5][6].A 39 year-old man was admitted in our coronary care unit for acute chest pain (b2 h). At admission, ECG found ST elevation through V1 to V4 leads with ST depression in D2, D3, and avF leads (Fig.…”

mentioning

confidence: 99%