替格瑞洛致心律失常不良反应文献分析

Literature analysis of adverse arrhythmia-induced effects of ticagrelor

目的:分析替格瑞洛致心律失常不良反应的发生情况及临床特点,为合理用药提供参考。方法:检索Cochrane图书馆、PubMed、Web of science、Springer link、Embase、Scopus、中国知网(CNKI)、万方期刊论文数据库、维普期刊数据库、中国生物医学文献数据库(CBM)中收载的替格瑞洛致心律失常不良反应文献进行统计分析,检索时间为2011年1月-2019年7月。结果:检索到14篇共15例关于替格瑞洛致心律失常不良反应个案报道,以男性为主(10例,66.67%),年龄50岁及以上患者12例(80%)。心律失常不良反应发生时间最短的是负荷剂量1 h后;最长为用药后2个月。其中10例(66.67%)患者在用药后10 h内出现不良反应。不良反应发生后有3例患者植入临时起搏器,1例患者在出院前植入永久性双腔起搏器,其他11例患者分别通过停药、继续用药、换用其他药物及对症治疗后,症状得到缓解或消失。结论:替格瑞洛可能通过抑制红细胞对腺苷的摄取,升高细胞外液腺苷的浓度,而引起心律失常的不良反应。对于传导系统已经受损的患者,临床上在联合用药时需注意药物的相互作用。临床合理使用替格瑞洛的同时,应加强用药监测,以减少不良反应的发生。

OBJECTIVE To analyze the occurrence and clinical characteristics of cardiovascular adverse reactions induced by ticagrelor and provide a reference for rational drug use.METHODS The literatures on adverse reactions of ticagrelor induced by arrhythmia listed in Cochrane Library,PubMed,Web of Science,Springer link,Embase,Scopus,China National Knowledge Infrastructure(CNKI),Wanfang Journal Article Database,VIP Journal Database and Chinese Biomedical Literature Database(CBM)were searched for statistical analysis from January 2011 to July 2019.RESULTS A total of 14 articles and 15 cases of adverse cardiovascular reactions caused by ticagrelor were identified.The majority of patients were males(10 cases,66.67%).There were 12 patients aged 50 and above(80%).Some arrhythmic adverse reactions occurred 1 h after loading dose,which was the shortest span between dosing and onset;the longest was 2 months after treatment.Among them,10(66.67%)patients experienced adverse reactions within 10 hours after treatment.After the occurrence of adverse reactions,3 patients were implanted with temporary pacemaker,1 patient was implanted with permanent dual-chamber pacemaker before discharge,and the other 11 patients’symptoms were relieved or disappeared after drug withdrawal,continuous medication,switching to other drugs and symptomatic treatment,respectively.CONCLUSION Ticagrelor may cause arrhythmia by inhibiting the uptake of adenosine by red blood cells and increasing the concentration of adenosine in extracellular fluid.For patients with impaired conduction system,the drug interaction should be paid attention when drugs were used in combination.In order to reduce the occurrence of adverse reactions,we should strengthen drug monitoring while using ticagrelor reasonably in clinical practice.