Arioti Manfredi, Sirianni Giovanni, Laudisa Maria Luisa, De Cesare Nicoletta Bianca
Dipartimento di Cardiologia, Policlinico San Marco, Zingonia, Gruppo San Donato.
Eur Heart J Case Rep. 2020 Aug 20;4(5):1-5. doi: 10.1093/ehjcr/ytaa156. eCollection 2020 Oct.
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.
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.
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.
替格瑞洛是一种广泛使用的P2Y12抑制剂，是急性冠状动脉综合征治疗以及部分经皮冠状动脉介入治疗（PCI）病例中的重要治疗药物。呼吸困难和心动过缓是最常见的副作用，但据报道后者的临床意义不大。
一名51岁男性因不稳定型心绞痛接受了左前降支和钝缘支的PCI治疗，接受了替格瑞洛负荷剂量（180毫克）。住院期间，在进行遥测监测时，记录到一次长达16秒的有症状的心室停搏，促使停用替格瑞洛并改用普拉格雷。
尽管在III期试验的专门分析中报告了心室停顿情况，但未记录到明显的临床后果。然而，一些报告表明，显著的缓慢性心律失常事件可能与替格瑞洛给药有关，表现为窦房结和房室传导障碍。我们报告了一例在给予负荷剂量后36小时发生心脏停搏的病例。
