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Ticagrelor enhanced coronary blood flow velocity, feeling of dyspnea
Study results have suggested that ticagrelor may enhance adenosine-induced coronary blood flow velocity and the sensation of dyspnea in healthy male patients through an adenosine-mediated mechanism.
To determine whether ticagrelor augments coronary blood flow and relieves dyspnea in humans, researchers randomly assigned 40 healthy male patients in a double blind, placebo-controlled study to receive a single dose of ticagrelor (Brilinta, AstraZeneca; 180 mg) or placebo in a crossover fashion. Patients received the alternative regimen after a washout period of 6 to 21 days. They measured coronary blood flow velocity (CBFV) by transthoracic Doppler echocardiography at rest after multiple stepwise adenosine infusions given before and after the drug or placebo, and again after the infusion of theophylline.
Adenosine-induced CBFV-area under the curve (AUC) increased 15% (95% CI, 9-21) with ticagrelor vs. 4% (95% CI; –1 to 10) for placebo. There was a significant increase in CBFV when adenosine was given at 50 mcg/kg/min and 80 mcg/kg/min (95% CI; 0.1-10.0 and 6.7- 29.1, respectively).
In both treatment groups, CBFV was significantly attenuated by theophylline, with no significant differences between patients receiving ticagrelor or placebo (P=.39).
Furthermore, ticagrelor significantly enhanced the sensation of dyspnea at adenosine doses of 110 mcg/kg/min and 140 mcg/kg/min, whereas no difference was seen in the placebo group.
“In addition to promoting myocardial perfusion, there are additional adenosine-mediated cardioprotective effects that may be enhanced in patients treated with ticagrelor, such as ischemic preconditioning, inhibition of inflammatory response and inhibition of platelet activation,” researchers wrote.
Disclosure: Wittfeldt reports no relevant financial disclosures. All of the other study researchers are employees of AstraZeneca. The study was supported by AstraZeneca.