Ticagrelor use after acute coronary syndrome with PCI can potentially result in significant, prolonged sinus pauses, which may necessitate transitioning to an alternative P2Y12 inhibitor.
Ticagrelor is an oral antiplatelet agent commonly used following percutaneous coronary intervention (PCI). There have been many reports describing bradyarrhythmias in the setting of ticagrelor use, most notably sinus pauses. This process is thought to be related to ticagrelor's inhibition of human equilibrative nucleoside transporter (hENT1), which reduces cellular uptake of adenosine. We present a case of a 58-year-old male who experienced prolonged sinus pauses 38 hours after starting ticagrelor following ST-elevation myocardial infarction with subsequent PCI and stent placement.
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Pavlatos et al. (2023) studied this question.
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