Ticagrelor Dyspnoea — RACP Adult Medicine MCQ
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Correct answer: A — Pulmonary embolism
Ticagrelor causes dyspnoea in 10–15% of patients through adenosine-mediated mechanisms (ticagrelor inhibits cellular adenosine uptake, increasing adenosine levels which stimulate pulmonary vagal C-fibres). It is dose-related, usually mild, often self-limiting within the first week, and does NOT represent cardiopulmonary pathology. Investigation to exclude cardiac and pulmonary causes is appropriate. If dyspnoea is intolerable and genuine, switching to clopidogrel or prasugrel may be necessary. Dyspnoea is NOT a reason to discontinue antiplatelet therapy without assessment.
Reference: AMH – 2025 – Ticagrelor; NHF/CSANZ – 2025 – ACS Guideline