Why the study?
The molecular mechanisms and corresponding management strategies for ticagrelor-related dyspnea and bradyarrhythmias have not been definitively established.
Ticagrelor use can be associated with significant bradyarrhythmias requiring a switch in antiplatelet therapy, highlighting the need for clinical management algorithms for its side effects.
May inform ticagrelor side-effect mechanisms in ACS; hypothesis-generating and should not yet change DAPT practice.
Ticagrelor is currently considered a first-line choice in dual antiplatelet therapy (DAPT) following revascularization of acute coronary syndrome (ACS). However, its use is correlated with an increased incidence of two side effects, dyspnea and bradyarrhythmias, whose molecular mechanisms have not yet been defined with certainty and, consequently, neither of the therapeutic decisions they imply. We report the case of a patient with acute myocardial infarction treated with ticagrelor and aspirin as oral antithrombotic therapy after primary percutaneous coronary intervention (PCI), manifesting in a significant bradyarrhythmic episode that required a switch of antiplatelet therapy. Starting from this case report, this article aims to gather the currently available evidence regarding the molecular mechanisms underlying these side effects and propose possible decision-making algorithms regarding their management in clinical practice.
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Cesarini et al. (2023) studied this question.
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