Case Report: Anti-platelet Medication Brilinta Caused Angioedema Reaction

Some patients taking Brilinta (ticagrelor) for a condition called acute coronary syndrome might develop hypersensitivity to the medication that manifests as angioedema and sudden breathing problems, a new case report shows.

The circumstances of a 69-year-old African man who developed angioedema shortly after receiving Brilinta was reported in the journal Case Reports in Cardiology.

The study, “Ticagrelor-Induced Angioedema: A Rare and Unexpected Phenomenon,” was led by researchers at the University of the West Indies, in Trinidad and Tobago.

Patients with certain cardiovascular conditions, and people seeking to avoid cardiac events, usually are treated with two types of anti-platelet agents. These agents, which include the aspirin, help prevent blood clotting, reducing the risk of cardiovascular events.

Patients with these conditions are treated with aspirin for the rest of their lives. But studies show that adding another anti-platelet agent — Brilinta, Plavix (clopidogrel), or Effient (prasugrel) – to the aspirin regimen may further reduce the incidence of cardiovascular events.

But with the addition of these agents, the prevalence of hypersensitivity reactions also has increased. Hypersensitivity is when the immune system develops undesirable reactions that cause allergies, or attacks the body’s own tissues and cells.

In this case report, researchers describe a patient who developed angioedema as response to a Brilinta-triggered allergic reaction.

The 69-year-old, who had a clinical history of coronary artery disease, went to the emergency department due to atypical chest pain. He was given aspirin and Brilinta to ease his heart symptoms.

In a physical evaluation, the patient revealed significant left-sided chest wall tenderness, but no additional changes. Cardiac biomarkers were within normal ranges, and vital signs revealed mild increased blood pressure.

However, one hour after receiving the Brilinta, the patient experienced a number of symptoms that included worsening chest pain, sudden breathing difficulty, and generalized urticaria (hives).

A second physical examination showed swelling around the eyes and angioedema. The patient immediately received hydrocortisone, ranitidine, and chlorphenamine intravenously, along with nebulized albuterol and ipratropium. The symptoms resolved within an hour.

“Based on the clinical scenario, the patient’s tentative diagnosis was [Brilinta]-induced hypersensitivity reaction with angioedema as this was the only new medication he was given,” the researchers said.

The study highlights the need for close follow-up of patients receiving anti-platelet therapies, as the adverse drug reactions may “precipitate respiratory distress requiring emergent airway management,” the team said.