Prolonged Asystole After a Loading Dose of Ticagrelor

Letters17 April 2018Prolonged Asystole After a Loading Dose of TicagrelorSabina Rosset, MD, Olivier Müller, MD, PhD, Etienne Pruvot, MD, and Patrizio Pascale, MDSabina Rosset, MDCentre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (S.R., O.M., E.P., P.P.), Olivier Müller, MD, PhDCentre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (S.R., O.M., E.P., P.P.), Etienne Pruvot, MDCentre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (S.R., O.M., E.P., P.P.), and Patrizio Pascale, MDCentre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (S.R., O.M., E.P., P.P.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0550 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Ticagrelor is a reversibly binding, direct, oral inhibitor of the adenosine diphosphate P2Y12 receptor that provides rapid and potent inhibition of platelet aggregation. The PLATO (Platelet Inhibition and Patient Outcomes) trial studied patients with acute coronary syndrome and found that ticagrelor was superior to clopidogrel when success was measured by a composite end point that included myocardial infarction, stroke, and death from vascular causes (1).Objective: To alert clinicians that a standard loading dose of ticagrelor can cause severe bradycardia.Case Report: A 40-year-old woman was referred to our hospital for suspected unstable angina. The patient was obese, had ...References1. Scirica BM, Cannon CP, Emanuelsson H, Michelson EL, Harrington RA, Husted S, et al; PLATO Investigators. The incidence of bradyarrhythmias and clinical bradyarrhythmic events in patients with acute coronary syndromes treated with ticagrelor or clopidogrel in the PLATO (Platelet Inhibition and Patient Outcomes) trial: results of the continuous electrocardiographic assessment substudy. J Am Coll Cardiol. 2011;57:1908-16. [PMID: 21545948] doi:10.1016/j.jacc.2010.11.056 CrossrefMedlineGoogle Scholar2. Teng R. Ticagrelor: Pharmacokinetic, pharmacodynamic and pharmacogenetic profile: an update. Clin Pharmacokinet. 2015;54:1125-38. [PMID: 26063049] doi:10.1007/s40262-015-0290-2 CrossrefMedlineGoogle Scholar3. Baker NC, Nadour W, Friehling M. Clinically significant ticagrelor induced conduction abnormalities following percutaneous coronary intervention. Int J Cardiol. 2016;214:21-2. [PMID: 27057966] doi:10.1016/j.ijcard.2016.03.143 CrossrefMedlineGoogle Scholar4. Goldberg A, Rosenfeld I, Nordkin I, Halabi M. Life-threatening complete atrioventricular block associated with ticagrelor therapy [Letter]. Int J Cardiol. 2015;182:379-80. [PMID: 25594929] doi:10.1016/j.ijcard.2014.12.162 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (S.R., O.M., E.P., P.P.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0550.This article was published at Annals.org on 19 December 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySinus Arrest Associated With Ticagrelor Therapy: A Case Report and Review of LiteratureA rare but serious complication of ticagrelor therapy: a case reportPremature Ticagrelor Discontinuation in Secondary Prevention of Atherosclerotic CVDTicagrelor 17 April 2018Volume 168, Issue 8Page: 602-603KeywordsAdenosineAttentionBradycardiaDisclosureElectrocardiographyHeartMyocardial infarctionPacemakersStable coronary artery diseaseSyncope ePublished: 19 December 2017 Issue Published: 17 April 2018 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...