Dyspnea in Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Patients on Dual Antiplatelets in a Tertiary Care Hospital in South India

Parvathy Krishnan, Sharmila Mohan, Doyce Jom, Roji Jacob, Siby Joseph, Rajesh Thachathodiyl and Vikrant Vijan

Background: For post Percutaneous Transluminal Coronary Angioplasty for Acute Coronary Syndromes, Dual Antiplatelet Therapy with Aspirin and a P2Y12 receptor inhibitor like Ticagrelor or Clopidogrel is required minimum for a period of 12 months. There are few studies which have shown the incidence of dyspnea in patients receiving antiplatelet therapy. Methods: In this retrospective, single centre, cohort study, patients who underwent PTCA and were on dual antiplatelets were randomly selected from the clopidogrel and ticagrelor group between July 2013 and June 2014. Patient’s relevant data were collected from electronic medical records and cross checked with manually maintained medical records wherever necessary. The study endpoint was incidence of dyspnoea within a follow up period of 9 months. Results: Among the 100 patients started on dual antiplatelet therapy with aspirin and ticagrelor, dyspnea occurred in 10% patients. Ticagrelor was substituted with clopidogrel in 60% cases. In 100 patients on clopidogrel, dyspnea occurred in 5% of patients, but clopidogrel was continued in all cases. Onset of dyspnea in patients on Ticagrelor occurred in 50% of patients in the first month of follow up, 10% cases at 3 months, 30% cases at 6 months and 10% cases at 9 months. But in clopidogrel group dyspnea occurred in 40% cases at 6 months follow up and 60% cases at 9 months. The p value on comparison of dyspnoea among the two groups was found to be 0.283, which was not statistically significant probably due to less sample population. Conclusion: Risk for dyspnoea induced by Ticagrelor was found to be higher than with Clopidogrel in the same ethnic groups when used as dual antiplatelet along with Aspirin. So it may not be a class effect or due to P2Y12 receptor inhibitory action alone.