Open AccessA rare but serious complication of ticagrelor therapy: a case report
Author(s) -
Manfredi Arioti,
Giovanni Sirianni,
Maria Luisa Laudisa,
Nicoletta B. De Cesare
Publication year - 2020
Publication title -
european heart journal. case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.256
H-Index - 5
ISSN - 2514-2119
DOI - 10.1093/ehjcr/ytaa156
Subject(s) - ticagrelor , medicine , conventional pci , acute coronary syndrome , cardiology , percutaneous coronary intervention , bradycardia , asystole , anesthesia , myocardial infarction , heart rate , blood pressure
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.