Abstract
Background: P2Y12 platelet receptor inhibitors (i.e., clopidogrel, prasugrel and ticagrelor) Ticagrelor are an oral, reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and more pronounced platelet inhibition than clopidogrel. The P2Y12 platelet receptor inhibitors are the cornerstone of treatment of ACS patients. The common adverse effects include upper gastrointestinal (GI) bleeding, ecchymosis, haematuria, epistaxis, and possibility of ticagrelor-induced Thrombotic thrombocytopenia purpura (TTP).
Aim: This study was conducted to determine the incidence of dyspnoea and/or bleeding as side effects of ticagrelor and compare it with commonly used P2Y12 platelet receptor inhibitors, clopidogrel.
Methods: A record based retrospective cohort study was conducted including all patients using ticagrelor or clopidogrel for clinical indications attending The Cardiology Outpatient Clinics at Aseer Central Hospital. Patients were classified into cohorts based on type of drug received. Patients' files were prospectively reviewed to extract data. Data were extracted using pre-structured data extraction format to avoid errors, missing and inter rater bias.
Results: The study included 200 patients; 100 (50%) received PLAVIX (clopidogrel) medication (group 1) and 100 (50%) received BRILINTA (ticagrelor) medication (group 2). Exactly 38% of group 1 cases aged 60 years or more were compared to 39% of group 2 patients with no statistical significance. As for gender, 58 (58%) of group 1 cases were males in comparison to 89 (89%) of group 2 cases (P=.001). Also, 18% of group 1 cases were smokers compared to 32.1% of group 2 cases (P=.026). Hypertension was reported among 46% of group 1 cases compared to 56% of group 2 patients (P=.179). Also, hypercholesterolemia was detected among 29% of group 1 cases compared to 41.7% of group 2 (P=.072). Considering DM, it was diagnosed among 50% of group 1 patients in comparison to 51% of group 2 patients (P=.872). History of bleeding was reported among 9 cases of group 1 compared to 5 cases in group 2 (P=.437).
Conclusion: A significant number of patients who were started on ticagrelor develop dyspnoea but not compromising the therapeutic superiority of the drug as compared to clopidogrel and can be replaced as first line drug in the Saudi population. Other side effect profiles of ticagrelor are comparable to conventional anti platelet drugs with no significant statistical variability.