Ticagrelor is a potent, direct P2Y 12 antagonist with rapid onset of action and intense platelet inhibition, indicated in patients with acute coronary syndromes (ACS) and planned primary percutaneous coronary intervention (pPCI). According to PLATO studies in patients with an increased risk of bradycardia, ticagrelor should be used with caution due to limited clinical experience. A 61-year-old woman, contacted EMS at 23:28 h on 10/05/2017 due to severe nausea and abdominal pain. EMS physician, on the patient’s history, physical examination and ECG findings, diagnoses STEMI (ST-elevation myocardial infarction) with AV block III0. He estimated that percutaneous coronary intervention (PCI) is indicated, provided dual antithrombotic therapy (acetylsalicylic acid and ticagrelor), and application of temporary transcutaneous pacing. The patient on the monitor was transported to the duty PCI center. She is hemodynamically stable all the time. Temporary pacing and PCI were applied at the hospital. There was a dilemma whether ticagrelor should be given to this patient or not. Despite opposing opinions of our physicians on tcagrelor use in STEMI patient with 3rd degree AV block, we should choose the best therapy for each patient individually. For our patient, this therapeutic option was crucial for survival.
Key words: ticagrelor, atrioventricular block III0, STEMI, percutaneous coronary intervention
Topic: MEDICINE