Ticagrelor Dyspnoea Management — EECC MCQ

Correct answer: C — Switch to a suitable alternative potent P2Y12 inhibitor

Ticagrelor-related dyspnoea occurs in 10-15% of patients and is caused by ticagrelor's inhibition of equilibrative nucleoside transporter 1 (ENT1), which increases extracellular adenosine levels. Adenosine stimulates C-fibre afferents in the lungs, causing a sensation of breathlessness that is typically not associated with objective impairment of lung function. While often self-limiting, it can be persistent and troublesome. Prasugrel (a thienopyridine prodrug like clopidogrel, but more potent and predictable) does not affect adenosine metabolism and does not cause dyspnoea. The 2023 ESC ACS Guidelines include switching from ticagrelor to prasugrel as a reasonable option for intolerable ticagrelor-related side effects. Prasugrel dose reduction to 5 mg is required for patients ≥75 years or weighing <60 kg.

Reference: ESC (2023): ACS Guidelines: https://bnf.nice.org.uk/