Abstract

Ticagrelor, P2Y12 trombosit reseptörlerine geri dönüşümlü olarak bağlanarak hareket eden yeni nesil antiplatelet ajanlarından biridir. Tikagrelorun aşırı doz alımı ile ilgili literatürle ilgili veriler oldukça sınırlıdır. Bu yazıda acil servise, intihar girişimi amacıyla 15 adet 90 mg ticagrelor içeren tablet(Brilinta® 90 mg tablet, Astra Zeneca Pharmaceuticals, İstanbul) alma şikayeti ile başvuran 23 yaşında bir erkek hasta sunuldu. Ticagrelor, ülkemizde akut koroner sendrom tedavisinde kullanılan yeni nesil antiplatelet ajanlardan biridir. İlacın intihar amaçlı veya kazayla aşırı dozda kullanılması, acil durum doktorları için nispeten yeni bir konudur. Bilgilerimize göre intihar amaçlı ticagrelor doz aşımı alımı, daha önce literatürde bildirilmemiş bir durumdur. Bu yazıda 1350 mg ticagrelor toksisitesi olan bir olgunun asemptomatik sürecini paylaştık. Ülkemizde ilacın kullanımının ve yaygınlığının artması ile acil hekimlerin tikagrelor zehirlenmesiyle daha yüksek oranda karşılaşabileceğini düşünüyoruz. Bu nedenle, tikagrelor zehirlenmesinde acil durum doktorlarının ilacı bilmesi ve tanıması gerekir. 

Keywords

• Acil tıp,intihar,ticagrelor,zehirlenme

Ticagrelor Intoxication: Overdose in a Suicidal Attempt

Abstract

Ticagrelor is one of the new generation antiplatelet agents, which acts by reversibly binding to P2Y12 platelet receptors. Literature-related data on overdose intake of ticagrelor is quite limited. Here, we report a 23-year old male patient, who presented to our emergency clinic (ER) with the complaint of suicidal intake of 15 tablets of 90 mg ticagrelor (Brilinta® 90 mg tablet, Astra Zeneca Pharmaceuticals, Istanbul). Ticagrelor is one of the new generation antiplatelet agents that is currently being used in the treatment of acute coronary syndrome in our country. The overdose use of the drug for suicidal purpose or accidentally, is a relatively new issue for ER physicians. According to our knowledge, suicidal ticagrelor overdose intake is a case that has not been reported in the literature previously. In this article, we shared the asymptomatic process of a case with 1350 mg ticagrelor toxicity. With the increased use and prevalence of the drug in our country, we think that the ER physicians may encounter ticagrelor poisoning at higher rates. Therefore, in ticagrelor poisoning, ER physicians need to be aware and familiar with the drug.

Keywords

• Emergency medicine,suicide,ticagrelor,intoxication

References

1. 1. Schömig A. Ticagrelor--is there need for a new player in the antiplatelet-therapy field? N Engl J Med 2009;361(11):1108-11.
2. 2. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;130(25):e344-426.
3. 3. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127(4):e362-425.
4. 4. Guimarães PO, Tricoci P. Ticagrelor, prasugrel, or clopidogrel in ST-segment elevation myocardial infarction: which one to choose? Expert Opin Pharmacother 2015;16(13):1983-95.
5. 5. Cannon CP, Husted S, Harrington RA, Scirica BM, Emanuelsson H, Peters G, et al. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. J Am Coll Cardiol 2007;50(19):1844-51.
6. 6. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361(11):1045-57.
7. 7. Storey RF, Becker RC, Harrington RA, Husted S, James SK, Cools F, et al. Characterization of dyspnoea in PLATO study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes. Eur Heart J 2011;32(23):2945-53.
8. 8. Parodi G, Storey RF. Dyspnoea management in acute coronary syndrome patients treated with ticagrelor. Eur Heart J Acute Cardiovasc Care 2015;4(6):555-60.

9. 9. Ticagrelor: Drug information. Available: December 1, 2015. Available at: http://www.uptodate.com/contents/ticagrelor-drug-information?source=search_result&search=ticagrelor&selectedTitle=1%7E50.