Resumen
Los antiagregantes plaquetarios son medicamentos ampliamente utilizados para la prevención y tratamiento de patologías aterotrombóticas, como lo es el síndrome coronario agudo. A pesar de tener un efecto benéfico, no están exentos de ocasionar múltiples alteraciones a nivel sistémico, como lo es la disnea en pacientes sometidos a manejo con ticagrelor. Se expone el caso de un paciente de 66 años con antecedente de cardiopatía isquémico-hipertensiva, tabaquismo pesado y alergia al ácido acetilsalicílico (ASA), con requerimiento de 2 arteriografías coronarias, quien presenta disnea en reposo en menos de 24 horas, posterior al inicio de manejo antiagregante tromboprofiláctico con ticagrelor, que resuelve de forma satisfactoria tras la suspensión del medicamento. Al ser un efecto secundario relativamente frecuente en el marco del uso del ticagrelor, se hace relevante revisar los hallazgos en la literatura actual sobre la aparición de disnea en pacientes tratados con dicho fármaco, para así tener en cuenta posibles recomendaciones acerca del manejo de la disnea asociada a ticagrelor, basadas en el conocimiento actual. MÉD.UIS.2022;35(1): 9-15.
Referencias
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14): 1289–367.
Westman PC, Lipinski MJ, Torguson R, Waksman R. A comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis. Cardiovasc Revasc Med. 2017;18(2):79-85.
Husted S, van Giezen JJ. Ticagrelor : The First Reversibly Binding Oral P2Y12 Receptor Antagonist. Cardiovasc Ther. 2009;27(4):259-74.
Lombardi N, Lucenteforte E, Torrini M, Balzi D, Barchielli A, Mugelli A, et al. Ticagrelor-related late-onset dyspnea as cause of emergency department visit: a 3-year outpatient study. J Cardiovasc Med (Hagerstown). 2018;19(6):284-9.
Giannoni A, Borrelli C, Gentile F, Mirizzi G, Coceani M, Paradossi U, et al. Central apnoeas and ticagrelor-related dyspnoea in patients with acute coronary syndrome. Eur Heart J Cardiovasc Pharmacother. 2021;7(3):180-8.
Krakowiak A, Kuleta J, Plech I, Zarębiński M, Wojciechowska M, Wretowski D, et al. Ticagrelor-Related Severe Dyspnoea: Mechanisms, Characteristic Features, Differential Diagnosis and Treatment. Clin Med Insights Case Rep. 2020 Oct 8;13:1179547620956634. DOI: https://doi.org/10.1177/1179547620956634. PMID: 33100831; PMCID: PMC7550933.
You SC, Rho Y, Bikdeli B, Kim J, Siapos A, Weaver J, et al. Association of Ticagrelor vs Clopidogrel with Net Adverse Clinical Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. JAMA. 2020;324(16):1640-50.
Patti G, Micieli G, Cimminiello C, Bolognese L. The Role of Clopidogrel in 2020: A Reappraisal. Cardiovasc Ther. 2020 Mar 16;2020:8703627. DOI: https://doi.org/10.1155/2020/8703627. PMID: 32284734; PMCID: PMC7140149.
Storey RF, Becker RC, Harrington RA, Husted S, James SK, Cools F, et al. Characterization of dyspnoea in PLATO study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes. Eur Heart J. 2011;32(23):2945-53.
Bonaca MP, Storey RF, Theroux P, Steg PG, Bhatt DL, Cohen MC, et al. Efficacy and Safety of Ticagrelor Over Time in Patients With Prior MI in PEGASUS-TIMI 54. J Am Coll Cardiol. 2017;70(11):1368-75.
Al-Salama ZT, Keating GM, Keam SJ. Ticagrelor: A Review in Long Term Secondary Prevention of Cardiovascular Events. Drugs. 2017;77(18):2025-36.
Arioti M, Sirianni G, Laudisa ML, De Cesare NB. A rare but serious complication of ticagrelor therapy: a case report. Eur Heart J Case Rep. 2020;4(5):1-5.
Akkaif MA, Ng ML, Sk Abdul Kader MA, Daud NAA, Sha’aban A, Ibrahim B. A review of the effects of ticagrelor on adenosine concentration and its clinical significance. Pharmacol Rep. 2021;73(6):1551-64.
Antonioli L, Fornai M, Blandizzi C, Pacher P, Haskó G. Adenosine signaling and the immune system. Immunol Lett. 2019;205:9-15.
Zhang N, Xu W, Li O, Zhang B. The risk of dyspnea in patients treated with third-generation P2Y12 inhibitors compared with clopidogrel: a meta- analysis of randomized controlled trials. BMC Cardiovasc Disord. 2020;20(1):140.
Sumaya W, Storey RF. Ticagrelor: Effects Beyond the P2Y12 Receptor. Interv Cardiol Clin. 2017;6(1):49-55.
Lamberts V, Baele P, Kahn D, Liistro G. Dyspnea or Cheyne-Stokes respiration associated with Ticagrelor? Sleep Med. 2018;43:4-6.
Levin LÅ, Wallentin L, Bernfort L, Andersson D, Storey RF, Bergström G, et al. Health-related quality of life of ticagrelor versus clopidogrel in patients with acute coronary syndromes-results from the PLATO trial. Value Health. 2013;16(4):574-80.
van der Meijden PEJ, Heemskerk JWM. Platelet biology and functions: new concepts and clinical perspectives. Nat Rev Cardiol. 2019;16(3):166-79.
Li X, Wang Q, Xue Y, Chen J, Lv Q. Ticagrelor Compared with Clopidogrel Increased Adenosine and Cyclic Adenosine Monophosphate Plasma Concentration in Acute Coronary Syndrome Patients. Basic Clin Pharmacol Toxicol.2017;120(6):610-4.
Hauswaldt J, Blaschke S. Dyspnoe [Dyspnea]. Internist (Berl). 2017;58(9):925-36.
Unverdorben M, Parodi G, Pistolesi M, Storey RF. Dyspnea related to reversibly-binding P2Y12 inhibitors: A review of the pathophysiology, clinical presentation and diagnostics. Int J Cardiol. 2016;202:167-73.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45.
Sanmartin-Fernandez M, Zamorano JL. Theophylline for Attenuating Ticagrelor-Related Dyspnea. Arq Bras Cardiol. 2021;117(1):146-8.
Furtado RHM, Venkateswaran RV, Nicolau JC, Gurmu Y, Bhatt DL, Storey RF, et al. Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS-TIMI 54 Trial. J Am Heart Assoc. 2020;9(10):e015785. DOI: https://doi.org/10.1161/JAHA.119.015785. PMID: 32410485; PMCID: PMC7660882.
Lindholm D, Storey RF, Christersson C, Halvorsen S, Grove EL, Braun OÖ, et al. Design and rationale of TROCADERO: A Trial Of Caffeine to Alleviate DyspnEa Related to ticagrelOr. Am Heart J. 2015;170(3):465-70.
Guerbaai RA, Mahata I, Maréchaux S, Le Jemtel TH, Ennezat PV. Is ticagrelor worth its high cost and side-effects? Acta Cardiol. 2019;74(2):93-8.
Fuertes Ferre G, Ferrer Gracia MC, Calvo Cebollero I. Acetylsalicylic acid desensitization in the new era of percutaneous coronary intervention. Med Clin (Barc). 2015;145(6):253-7.
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.