S.O.D. Cardiologia Interventistica d'Urgenza, AOU Careggi, 50134 Florence, Italy.
Atherothrombotic Center, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, 50134 Florence, Italy.
Int J Mol Sci. 2023 Jun 29;24(13):10844. doi: 10.3390/ijms241310844.
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.
替格瑞洛目前被认为是急性冠脉综合征（ACS）血运重建后双联抗血小板治疗（DAPT）的首选药物。然而，其使用与呼吸困难和缓心律失常这两种副作用的发生率增加相关，但其分子机制尚未明确，因此也无法确定这两种副作用所暗示的治疗决策。我们报告了一例急性心肌梗死患者，在初次经皮冠状动脉介入治疗（PCI）后接受替格瑞洛和阿司匹林作为口服抗血栓治疗，表现为严重的缓心律失常发作，需要转换抗血小板治疗。从这个病例报告出发，本文旨在收集目前关于这些副作用的分子机制的现有证据，并提出在临床实践中管理这些副作用的可能决策算法。
