ticagrelor and Hemoptysis

A 55-year-old man presented with acute ST-elevation myocardial infarction. He received rescue angioplasty with one drug eluting stent. He developed marked breathlessness and haemoptysis two days later. Investigations led to the diagnosis of pulmonary haemorrhage, possibly from pneumonitis caused by ticagrelor. He was successfully managed with high-dose steroids and ticagrelor was replaced with clopidogrel. On stopping the steroids a month later, mild haemoptysis recurred and this was managed conservatively. Pneumonitis and pulmonary haemorrhage is rarely reported with acute myocardial infarction, but poses serious challenge to the patient and the clinician. Diagnosis may be delayed as breathlessness can occur due to myriad causes after myocardial infarction. Interrupting dual anti-platelet therapy after angioplasty could lead to devastating stent thrombosis.

Topics: Adenosine; Angioplasty; Hemoptysis; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Pneumonia; Purinergic P2Y Receptor Antagonists; Radiography, Thoracic; Thrombosis; Ticagrelor

We report a case of significant pulmonary hemorrhage developing shortly after commencing ticagrelor and aspirin therapy and requiring coronary artery bypass grafting to safely cease the antiplatelet therapy. Lung biopsy findings were consistent with drug-induced lung injury. Clinicians should be aware of this significant adverse event with this drug class.

Topics: Acute Coronary Syndrome; Adenosine; Aspirin; Biopsy; Coronary Artery Bypass; Diagnosis, Differential; Hemoptysis; Humans; Lung; Male; Middle Aged; Platelet Aggregation Inhibitors; Pneumonia; Purinergic P2Y Receptor Antagonists; Ticagrelor; Tomography, X-Ray Computed