Ticagrelor is an antiplatelet agent used to prevent atherothrombotic events. This article systematically introduces its common and serious adverse effects, as well as corresponding alleviation and management strategies.
I. Adverse Effects
1. Bleeding-related adverse effects
(1) Ticagrelor affects blood coagulation, thus the most common adverse effects are related to bleeding.
(2) Bleeding can occur in any part of the body, commonly presenting as bruising and epistaxis.
(3) Serious bleeding, although uncommon, may be life-threatening.
(4) Clinical studies have shown that the rate of treatment discontinuation due to adverse events is higher in the ticagrelor group compared to the control group, with bleeding and dyspnea being the most frequently reported reactions.
2. Intracranial and gastrointestinal bleeding
(1) Intracranial hemorrhage is an uncommon adverse effect, which may manifest as sudden limb numbness or weakness, speech difficulties, gait imbalance, severe headache, and other symptoms.
(2) In addition, gastrointestinal bleeding, hematuria, melena, or hematochezia may also occur.
(3) In the PEGASUS study, the incidence of TIMI-defined major bleeding was significantly higher in the ticagrelor group than in the aspirin monotherapy group.
3. Dyspnea and other adverse effects
(1) Dyspnea is a very common adverse effect of ticagrelor, reported by approximately 13.8% of patients. It is mostly mild to moderate in severity, often occurs within the first few weeks of treatment, and usually resolves spontaneously in most cases.
(2) Other common adverse effects include headache, dizziness, diarrhea, nausea, constipation, rash, pruritus, gout attack, hypotension, gingival bleeding, etc.
(3) In rare cases, thrombotic thrombocytopenic purpura may occur and requires emergency management.
II. Methods to Alleviate Adverse Effects
1. Management of bleeding risk
(1) When using ticagrelor, physicians weigh the bleeding risk against the benefit of preventing thrombotic events.
(2) Caution should be exercised in patients at high risk of bleeding. In case of major bleeding, platelet transfusion may be ineffective; antifibrinolytic therapy (e.g., tranexamic acid) or recombinant factor VIIa may be considered.
(3) Once the bleeding cause is identified and controlled, ticagrelor therapy may be resumed.
2. Management before surgery and for dyspnea
(1) If elective surgery is required, ticagrelor should be discontinued 5 days before the procedure.
(2) Patients should inform their doctor in advance that they are taking this medication. For dyspnea, if symptoms are intolerable, discontinuation should be considered.
(3) Most dyspnea is mild to moderate, with about 30% of episodes resolving within 7 days, and usually does not require drug discontinuation.
3. Monitoring of uric acid and renal function
(1) Hyperuricemia may occur during treatment, and caution is advised in patients with a history of gout.
(2) Renal function monitoring is recommended according to routine clinical practice.
(3) For patients with acute coronary syndrome, it is recommended to repeat renal function tests one month after initiating therapy, especially in patients aged >75 years, those with moderate to severe renal impairment, and those taking angiotensin receptor blockers concomitantly.
