Abstract
BackgroundTicagrelor is a reversible and direct-acting oral antagonist of the adenosine diphosphate receptor P2Y12. Possible adenosine-mediated effects of ticagrelor on inflammation are complex and incompletely understood. To our knowledge, ticagrelor-induced systemic inflammatory response syndrome (SIRS) has not yet been described.Case presentationWe report the case of an 84 years old patient presenting with SIRS subsequent to initiation of ticagrelor after implantation of two drug eluting stents. A broad diagnostic work-up for alternative causes and therapeutic measures were unrevealing. Discontinuation of the agent was followed by rapid improvement in clinical and laboratory signs of SIRS.ConclusionsAfter exclusion of other causes, ticagrelor needs to be considered as a possible causative agent for SIRS. Due to the widespread use of ticagrelor, clinicians should be aware of this possible adverse drug reaction.
Highlights
Ticagrelor is a reversible and direct-acting oral antagonist of the adenosine diphosphate receptor P2Y12
Symptoms, signs, and laboratory signs (CRP) of systemic inflammatory response syndrome (SIRS) persisted despite 6 days of intravenous antibiotic treatment (Fig. 1)
After broad, unrevealing diagnostic work-up ticagrelor was suspected as the causative agent of persistent SIRS due to recent initiation and no other change in drug treatment
Summary
Ticagrelor is a reversible and direct-acting oral antagonist of the adenosine diphosphate receptor P2Y12. Due to the lower incidence of sepsis and pulmonary adverse events as well as lower mortality in patients taking ticagrelor versus clopidogrel, such effects were previously considered to be beneficial. Initial laboratory findings showed substantially elevated C-reactive protein (CRP) (84 mg/l) and serum creatinine (159 μmol/l).
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