Antithrombotic Therapy in Special and Overlooked Populations with Cardiovascular Diseases

A Special Issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425) belonging to the section "Cardiovascular Clinical Research".

Deadline for manuscript submissions: closed (30 April 2026) | Viewed by 1983

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Guest Editor
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Interests: ischemic heart disease; antithrombotic therapy; risk stratification; acute coronary syndromes; structural interventions
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Special Issue Information

Dear Colleagues,

Guidelines often underrepresent real-life patients: the elderly, those with polypharmacy, cancer, chronic inflammation, or end-stage renal disease. This Special Issue aims at providing updated insights into the management of antithrombotic therapy in “difficult-to-treat” populations. Topics include adaptations in frail patients, cardio-oncology interfaces, antithrombotics in dialysis and transplant candidates, and management in rare or overlapping syndromes. Clinical studies, expert perspectives, and practical approaches are all welcome.

You may choose our Joint Special Issue in JCM.

Prof. Dr. Leonardo De Luca
Guest Editor

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Keywords

  • antithrombotic therapy
  • high-risk patients
  • PCI
  • bleeding risk
  • atrial fibrillation
  • individualized treatment
  • real-world evidence
  • complex cardiovascular disease

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Published Papers (1 paper)

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10 pages, 5014 KB  
Case Report
Unveiling the Hidden Risk: Ticagrelor-Induced Bradyarrhythmias and Conduction Complications in ACS Patients—Case Series
by Aleksandra Gorzynska-Schulz, Damian Stencelewski, Ludmiła Daniłowicz-Szymanowicz, Monika Lica-Gorzynska, Agata Firkowska and Elżbieta Wabich
J. Cardiovasc. Dev. Dis. 2026, 13(1), 7; https://doi.org/10.3390/jcdd13010007 - 22 Dec 2025
Cited by 1 | Viewed by 1476
Abstract
Background: Ticagrelor is a reversible, direct inhibitor of the platelet adenosine diphosphate (P2Y12) receptor, widely used in combination with acetylsalicylic acid (ASA) as dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) to prevent cardiovascular events. Despite its well-established efficacy, ticagrelor [...] Read more.
Background: Ticagrelor is a reversible, direct inhibitor of the platelet adenosine diphosphate (P2Y12) receptor, widely used in combination with acetylsalicylic acid (ASA) as dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) to prevent cardiovascular events. Despite its well-established efficacy, ticagrelor may cause adverse effects ranging from common ones (e.g., bleeding, dyspnea) to rare but potentially serious reactions such as bradyarrhythmias. These rare events are likely related to elevated adenosine levels secondary to inhibition of the human equilibrative nucleoside transporter 1 (hENT1). Methods: We describe two clinical cases of ticagrelor-associated bradyarrhythmia observed in patients following ACS. Both cases were analyzed in terms of clinical presentation, ECG findings, management strategy, and outcomes after discontinuation of the drug. Results: The first case concerns a 67-year-old woman with non-ST-segment elevation myocardial infarction (NSTEMI) who developed complete atrioventricular block (third degree) with a 45 s asystolic pause and syncope. The second case involves a 67-year-old man with anterior ST-segment elevation myocardial infarction (STEMI) who experienced recurrent sinus pauses lasting up to 5 s. In both cases, symptoms resolved following ticagrelor discontinuation and theophylline administration. No recurrence of arrhythmia was observed after switching to prasugrel. Conclusions: Ticagrelor-induced bradyarrhythmias, although rare, represent an important and reversible adverse effect that clinicians should be aware of, particularly during the early post-ACS phase. Prompt recognition and drug withdrawal may prevent severe outcomes and avoid unnecessary interventions such as pacemaker implantation. Further studies are warranted to identify patient-specific risk factors predisposing to ticagrelor-related conduction disturbances. Full article
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