Abstract
Patients with atrial fibrillation who have concurrent coronary artery disease requiring percutaneous coronary intervention are subsequently prescribed dual antiplatelet therapy and anticoagulation resulting in triple therapy (TT). Ticagrelor, a reversibly binding P2Y12 antiplatelet agent, has shown superiority to clopidogrel in prevention of ischemic events and death, but is also associated with a small increase in the incidence of intracranial bleeding. This bleeding risk may be enhanced in the setting of TT. The objective of this report is to describe a case of a 70-year-old male prescribed TT with ticagrelor and to review the current literature on the safety of ticagrelor as a part of TT.
Highlights
Patients with atrial fibrillation who have concurrent coronary artery disease requiring percutaneous coronary intervention are subsequently prescribed dual antiplatelet twice daily and discharged home
-c percutaneous coronary intervention (PCI) n during their lifetime.1. Such patients require the combination of oral o anticoagulation with dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, known collectively as triple therapy (TT)
While most patients studied on TT were on clopidogrel as the P2Y12 inhibitor,16-18 recent meta-analyses of patients on TT or DT have shown a higher rate of bleeding with ticagrelor as compared to clopidogrel
Summary
A 70-year-old man with medical history significant for coronary artery disease s/p CABG, hypertension, type 2 diabetes mellitus, AF, COPD, aortic stenosis s/p bioprosthetic aortic valve replacement, underwent cardiac catheterization and PCI with drug. Patients with atrial fibrillation who have concurrent coronary artery disease requiring percutaneous coronary intervention are subsequently prescribed dual antiplatelet twice daily and discharged home. Three days later, he was found unresponsive on the floor and subsequently brought to the emergency room. Ticagrelor, a reversibly binding P2Y12 antiplatelet agent, has ly shown superiority to clopidogrel in prevenn tion of ischemic events and death, but is associated with a small increase in the o incidence of intracranial bleeding. -c percutaneous coronary intervention (PCI) n during their lifetime.1 Such patients require the combination of oral o anticoagulation (depending on CHA2DS2N VASC score) with dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, known collectively as triple therapy (TT). Due to persistent major neurological deficits, including left sided paralysis and aphasia, he was discharged to a rehabilitation center
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