From the Guidelines
Ticagrelor can cause several side effects, including bleeding, dyspnea, bradycardia, and others, which can impact morbidity, mortality, and quality of life, and therefore, its use should be carefully monitored and managed. When considering the side effects of ticagrelor, it is essential to weigh the benefits against the risks, particularly in patients with a history of bleeding or other comorbidities. The most common side effects of ticagrelor include:
- Bleeding, which can range from minor bruising to serious internal bleeding 1
- Dyspnea (shortness of breath), which occurs in up to 15% of patients within the first week of treatment, but is rarely severe enough to cause discontinuation of treatment 1
- Bradycardia (slow heart rate) 1
- Other less common side effects, such as headache, dizziness, nausea, and diarrhea 1 It is crucial to note that the benefit of ticagrelor over clopidogrel was limited to patients taking 75 mg to 100 mg of aspirin 1. Additionally, the short half-life of ticagrelor requires twice-daily administration, which could potentially result in adverse events in non-compliant patients, particularly after stent implantation 1. The decision to use ticagrelor should be based on a careful assessment of the individual patient's risk factors and medical history, and patients should be closely monitored for signs of bleeding or other adverse effects. In general, the use of ticagrelor should be avoided in patients with a history of intracranial bleeding, and caution should be exercised when using ticagrelor in combination with other anticoagulants or antiplatelets 1. Overall, the management of ticagrelor side effects requires a comprehensive approach that takes into account the individual patient's needs and medical history.
From the Research
Ticagrelor Side Effects
Ticagrelor is a non-thienopyridine ADP inhibitor that prevents platelet activation and aggregation, and its major safety concern is bleeding 2. Some common adverse effects of ticagrelor include:
- Dyspnea: a common side effect that appears to be mild and self-limited 2, 3, 4
- Ventricular pauses: ticagrelor can cause ventricular pauses ≥3 seconds 4
- Elevation of serum creatinine and uric acid: ticagrelor can cause an increase in serum creatinine and uric acid levels 4
- Diarrhea: ticagrelor-induced diarrhea has been reported in some patients 5
- Bleeding: ticagrelor is associated with an increased risk of bleeding, including gastrointestinal bleeding 2, 5, 6
- Bradyarrhythmias: ticagrelor can cause bradyarrhythmic episodes, which can be significant in some cases 3
Comparison with Clopidogrel
Ticagrelor has been compared with clopidogrel in several studies, and the results show that:
- Ticagrelor has a faster and more consistent inhibition of platelet aggregation than clopidogrel 2, 4
- Ticagrelor has a similar safety profile to clopidogrel, with a slightly higher risk of bleeding in some patient populations 6
- Ticagrelor has been shown to have a mortality benefit in patients with acute coronary syndromes, making it a preferred agent over clopidogrel in some cases 2