A rare but serious complication of ticagrelor therapy: a case report. Issue 5 (20th August 2020)

• Record Type: Journal Article
• Authors: Arioti, Manfredi; Sirianni, Giovanni; Laudisa, Maria Luisa; De Cesare, Nicoletta Bianca
• Editors: Dastidar, Amardeep Ghosh; Deharo, Pierre; Mehta, Ojas H; Carazo, Carlos Minguito; Patel, Peysh A
• Is Part Of: European heart journal. Volume 4:Issue 5(2020)
• Page Start: 1
• Page End: 5
• Publication Date: 2020-08-20
• Subjects: Ticagrelor -- Side effect -- Acute coronary syndrome -- Asystole -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytaa156
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: 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.