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Ticagrelor-Related Severe Dyspnoea: Mechanisms, Characteristic Features, Differential Diagnosis and Treatment
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Managament of Ticagrelor-Related Dyspnoea
Although the attacks of bradycardia and dyspnoea can be shocking, in most of cases they are mild, transient and occur in the first week of treatment.1,2 Monitoring the patient for 3 to 4 days without stopping the ticagrelor therapy is recommended, as the attacks will probably disappear after that time.1,2,34,40 Sometimes however these side effects are life-threatening or highly intolerable by the patient, which leads to discontinuation of the ticagrelor therapy. Based on published case reports theophylline infusions may have positive effect on those symptoms, causing their remission.41 Our experiences with the drug are similar, but there is a need for evidence from clinical trials.42 As in none of the clinical trials using ticagrelor, patients were treated with theophylline or other methylxanthine drugs, currently there is no recommendation on this aspect neither by European Medicines Agency nor Food and Drug Administration.
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