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Despite this, ticagrelor has been shown to have side effects not seen by other anti-platelets, including shortness of breath, bradycardia and sinus pauses. These side effects are thought to be due to ticagrelor\u2019s second molecular target, human equilibrative nucleoside transporter 1, which leads to an increase in extracellular adenosine levels. This rise in adenosine is thought to trigger these adverse effects. This case report presents an example of an individual who has experienced these adenosine-driven side effects after starting ticagrelor and provides a review of the underlying adenosine-driven mechanisms.<\/jats:p>","DOI":"10.1136\/bcr-2025-266221","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:30:16Z","timestamp":1768231816000},"page":"e266221","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Ticagrelor-induced sinus pause: an adenosine-driven side effect"],"prefix":"10.1136","volume":"19","author":[{"given":"John Keenan","family":"Fanning","sequence":"first","affiliation":[{"name":"Radiology, Mackay Base Hospital, Mackay, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew Austin Bowerman","family":"Barnes","sequence":"additional","affiliation":[{"name":"Anesthesiology, Mackay Base Hospital, Mackay, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fraser","family":"Betley","sequence":"additional","affiliation":[{"name":"Anesthesiology, Mackay Base Hospital, Mackay, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachin","family":"Sondhi","sequence":"additional","affiliation":[{"name":"Cardiology, Mackay Base Hospital, Mackay, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"2026011207300461000_19.1.e266221.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.002589"},{"key":"2026011207300461000_19.1.e266221.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.01.003"},{"key":"2026011207300461000_19.1.e266221.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"2026011207300461000_19.1.e266221.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.11.056"},{"key":"2026011207300461000_19.1.e266221.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr231"},{"key":"2026011207300461000_19.1.e266221.6","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-707844"},{"key":"2026011207300461000_19.1.e266221.7","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00913.2004"},{"key":"2026011207300461000_19.1.e266221.8","unstructured":"Dakkak W , Doukky R . 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