Ticagrelor therapy in patients with advanced conduction disease: Is it really safe?

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

doi:10.1016/j.ijcard.2015.08.200

Cited by 6 publications

(1 citation statement)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Goldberg et al[6] published the case of a 71-year-old female patient with ACS and proximal LAD occlusion, treated with thrombus aspiration and stent implantation. On ECG, she had complete left bundle branch block (LBBB) and was not taking beta-blockers.…”

Section: Case Reportmentioning

confidence: 99%

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

Maria¹,

Borghi²,

Modonesi³

et al. 2017

WJCC

View full text Add to dashboard Cite

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.

show abstract

Section: Case Reportmentioning

confidence: 99%

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

Maria¹,

Borghi²,

Modonesi³

et al. 2017

WJCC

View full text Add to dashboard Cite

show abstract

Another side effect of ticagrelor: Atrial fibrillation

Zhang

Chen

Zhao

et al. 2016

International Journal of Cardiology

View full text Add to dashboard Cite

A rare but serious complication of ticagrelor therapy: a case report

Arioti

Sirianni

Laudisa

et al. 2020

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Background Ticagrelor is a widely used P2Y12 inhibitor and represents a fundamental therapeutic agent in acute coronary syndrome treatment and selected post-percutaneous coronary intervention (PCI) cases. Dyspnoea and bradycardia are the most common side effects but the latter has been reported to be of trivial clinical significance Case summary A 51-year-old gentleman underwent PCI to left anterior descending and obtuse marginal for unstable angina receiving a loading dose of ticagrelor (180 mg). During hospital stay, whilst on telemetry monitoring, a 16 s long, symptomatic, asystolic ventricular standstill was recorded prompting ticagrelor interruption and a switch to prasugrel. Discussion Despite ventricular pauses have been reported in dedicated analyses of Phase III trials, no apparent clinical consequences were documented. However, several reports have shown that significant brady-arrhythmic events might be linked to ticagrelor administration presenting both as sino-atrial and atrio-ventricular conduction disturbances. We report a case of asystole occurring 36 h after the administration of a loading dose.

show abstract

Ticagrelor therapy in patients with advanced conduction disease: Is it really safe?

Cited by 6 publications

References 3 publications

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

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

Another side effect of ticagrelor: Atrial fibrillation

A rare but serious complication of ticagrelor therapy: a case report

Contact Info

Product

Resources

About