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一例有趣的替格瑞洛诱发长QTc间期的病例系列报道。

An interesting case series of ticagrelor induced long QTc.

作者信息

Farzaei Alireza, Mehrabi Nasab Entezar, Jenab Yaser, Amirzadegan Alireza, Khodayari Javazm Alireza, Eisvand Mokhtar, Hajzeinolabedini Fateme, Bozorgi Ali

机构信息

Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran.

Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Int J Cardiol Cardiovasc Risk Prev. 2024 Jul 17;22:200311. doi: 10.1016/j.ijcrp.2024.200311. eCollection 2024 Sep.

DOI:10.1016/j.ijcrp.2024.200311
PMID:39131771
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11315159/
Abstract

This case series explores three patients who underwent percutaneous coronary intervention (PCI) and experienced prolonged QT intervals under treatment with Ticagrelor. The first case was a female who presented with chest pain and received a Xience stent. The second case involved a male patient who received two Xience stents. The third case was that of a male patient with LAD stenosis. All three patients received Ticagrelor and exhibited prolonged QTc intervals on their electrocardiograms (ECGs), which was resolved after switching to Clopidogrel. Thus far, the potential impact of Ticagrelor on QT prolongation has not been adequately addressed in the literature. It is hypothesized that Ticagrelor can block adenosine uptake by red blood cells, which may explain QTc prolongation. The results of this case series indicate that Ticagrelor may prolong QTc intervals. Consequently, it is imperative that clinicians are aware of this previously unlisted side effect and that patients are closely monitored while seeking alternative medications to manage the condition.

摘要

本病例系列研究了3例接受经皮冠状动脉介入治疗(PCI)并在使用替格瑞洛治疗期间出现QT间期延长的患者。第一例是一名出现胸痛并接受了依维莫司洗脱支架(Xience支架)的女性患者。第二例是一名接受了两枚依维莫司洗脱支架的男性患者。第三例是一名患有左前降支(LAD)狭窄的男性患者。所有3例患者均接受了替格瑞洛治疗,且心电图(ECG)显示QTc间期延长,在换用氯吡格雷后QTc间期恢复正常。迄今为止,替格瑞洛对QT间期延长的潜在影响在文献中尚未得到充分探讨。据推测,替格瑞洛可阻断红细胞对腺苷的摄取,这可能解释了QTc间期延长的原因。本病例系列的结果表明,替格瑞洛可能会延长QTc间期。因此,临床医生必须意识到这种先前未列出的副作用,并且在寻找替代药物治疗病情时,必须对患者进行密切监测。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d9e/11315159/6b61fd89f9d4/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d9e/11315159/44c52cacdb7b/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d9e/11315159/b3e8b7459cb6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d9e/11315159/6b61fd89f9d4/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d9e/11315159/44c52cacdb7b/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d9e/11315159/b3e8b7459cb6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d9e/11315159/6b61fd89f9d4/gr3.jpg

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本文引用的文献

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QT interval dynamics in patients with ST-elevation MI.ST段抬高型心肌梗死患者的QT间期动态变化
Front Cardiovasc Med. 2023 Jan 6;9:1056456. doi: 10.3389/fcvm.2022.1056456. eCollection 2022.
2
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Case Rep Cardiol. 2019 Nov 7;2019:5984847. doi: 10.1155/2019/5984847. eCollection 2019.
3
Ticagrelor increases adenosine plasma concentration in patients with an acute coronary syndrome.替格瑞洛增加急性冠脉综合征患者的血浆腺苷浓度。
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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.PLATO(血小板抑制和患者结局)试验中接受替格瑞洛或氯吡格雷治疗的急性冠脉综合征患者的缓心律失常和临床缓心律失常事件的发生率:连续心电图评估子研究结果。
J Am Coll Cardiol. 2011 May 10;57(19):1908-16. doi: 10.1016/j.jacc.2010.11.056.
6
Single-dose ticagrelor does not prolong the QT interval in healthy subjects.单剂量替格瑞洛不会延长健康受试者的QT间期。
Int J Clin Pharmacol Ther. 2010 Oct;48(10):643-51. doi: 10.5414/cpp48643.
7
Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation.医院环境中尖端扭转型室速的预防:美国心脏协会和美国心脏病学基金会的科学声明
Circulation. 2010 Mar 2;121(8):1047-60. doi: 10.1161/CIRCULATIONAHA.109.192704. Epub 2010 Feb 8.
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Drug induced QT prolongation.药物引起的 QT 间期延长。
Cardiol J. 2007;14(6):523-33.
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