Ticagrelor plasma concentration, metabolite ratio, and LDH level as independent risk factors for ticagrelor-induced dyspnea in ACS patients

Introduction Ticagrelor-induced dyspnea is a significant clinical concern and is associated with adverse outcomes. However, the specific risk factors leading to ticagrelor-induced dyspnea have not been fully elucidated. This study aims to identify risks by testing plasma concentrations of ticagrelor and its active metabolite, as well as other clinical factors that contribute to the risk. Methods A total of 102 patients undergoing antiplatelet therapy (ticagrelor and aspirin) were enrolled, including 23 who developed ticagrelor-induced dyspnea and 79 who did not. Plasma levels of ticagrelor and its active metabolite, AR-C124910XX, were measured using high-performance liquid chromatography (HPLC). Clinical characteristics of all enrolled patients were collected completely. The influencing factors of ticagrelor-induced dyspnea were analyzed using logistic regression analysis, and the correlation between patient characteristics and plasma peak concentrations was examined using correlation analysis. Results Compared with the non-dyspnea group, LDH levels and the ticagrelor metabolite ratio (AR-C124910XX/ticagrelor concentration ratio, TMR) decreased markedly in patients who developed dyspnea (LDH: OR =0.814 per 10 U/L, P = 0.027; TMR: OR =0.523 per 0.1 increase, P = 0.008). In contrast, peak ticagrelor concentration was markedly higher in the dyspnea group ( OR =1.173 per 100 ng/mL, P = 0.012). The plasma peak concentration of ticagrelor was negatively related to LDH ( r = −0.316, P = 0.001). Conclusion The peak concentration of ticagrelor, plasma LDH level, and the TMR are important risk factors for associated with ticagrelor-induced dyspnea in ACS patients. The plasma concentration of ticagrelor is negatively correlated with the level of LDH.