Alshammari Abdullah S, Shalwala Amer A, Alnuhait Mohammed A, Alhazmi Abdulfattah Y, Fagieha Refal E, Hallabi Nura Bin, Alandijani Eyad A, Aloufi Mansour A, Alharbi Mudhhi S, Alzahrani Reem S, Elkholy Emad M, Elrggal Mahmoud E, Alotaibi Abdulmalik S
Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.
Pharmacy Department, King Abdulaziz Hospital, Makkah, Saudi Arabia.
Ther Clin Risk Manag. 2025 Jun 8;21:861-867. doi: 10.2147/TCRM.S515732. eCollection 2025.
Ticagrelor is a widely used antiplatelet agent approved in over 70 countries, including the European Union and the United States, for reducing thrombotic events in patients with acute coronary syndromes (ACS). In clinical practice, combining ticagrelor with high-intensity statins is considered standard therapy for ACS. However, recent pharmacodynamic studies and case reports suggest potential drug-drug interactions that may increase the risk of adverse events, particularly muscular and renal complications. This study aimed to evaluate these risks in a real-world clinical setting in Saudi Arabia.
This retrospective observational cohort study was conducted at the Makkah Cardiology Center, Saudi Arabia. The study included adult patients (n = 577) who were prescribed high-intensity statins, with or without concurrent ticagrelor. The primary outcomes were the incidence of statin-associated muscular complications-defined as myalgia, myopathy, myositis, or rhabdomyolysis-and acute kidney injury (AKI). Clinical data were extracted from the hospital information system, and statistical comparisons were conducted between patients receiving statin monotherapy and those receiving combination therapy.
The cohort consisted predominantly of male patients (74.5%). Muscle-related complications were significantly more common in the group receiving both ticagrelor and statins (20.2%) compared to the statin-only group (10.5%) (P = 0.001). Among comorbid conditions, hypertension was the only factor significantly associated with a higher incidence of muscle-related complications. Although a trend toward increased AKI incidence was observed in the combination therapy group, this difference did not reach statistical significance.
This study highlights potential safety concerns related to the co-administration of ticagrelor and high-intensity statins, particularly the increased risk of muscle-related complications. While the findings on AKI were inconclusive, the results support the need for cautious use of this combination and call for larger prospective studies to further evaluate its safety profile and optimize treatment strategies.
替格瑞洛是一种广泛使用的抗血小板药物，在包括欧盟和美国在内的70多个国家被批准用于降低急性冠状动脉综合征（ACS）患者的血栓形成事件。在临床实践中，将替格瑞洛与高强度他汀类药物联合使用被认为是ACS的标准治疗方法。然而，最近的药效学研究和病例报告表明，可能存在药物相互作用，这可能会增加不良事件的风险，尤其是肌肉和肾脏并发症。本研究旨在评估沙特阿拉伯实际临床环境中的这些风险。
这项回顾性观察队列研究在沙特阿拉伯麦加心脏病中心进行。该研究纳入了成年患者（n = 577），这些患者被处方使用高强度他汀类药物，无论是否同时使用替格瑞洛。主要结局是他汀类药物相关肌肉并发症（定义为肌痛、肌病、肌炎或横纹肌溶解）和急性肾损伤（AKI）的发生率。临床数据从医院信息系统中提取，并对接受他汀类药物单药治疗的患者和接受联合治疗的患者进行了统计比较。
该队列主要由男性患者组成（74.5%）。与仅使用他汀类药物的组（10.5%）相比，同时接受替格瑞洛和他汀类药物的组中肌肉相关并发症明显更常见（20.2%）（P = 0.001）。在合并症中，高血压是与肌肉相关并发症发生率较高显著相关的唯一因素。虽然在联合治疗组中观察到AKI发生率有增加的趋势，但这种差异未达到统计学意义。
本研究强调了替格瑞洛与高强度他汀类药物联合使用相关的潜在安全问题，特别是肌肉相关并发症风险增加。虽然关于AKI的研究结果尚无定论，但结果支持谨慎使用这种联合用药，并呼吁进行更大规模的前瞻性研究，以进一步评估其安全性并优化治疗策略。
