Table 3. Management recommendations of adverse effects of antiplatelet therapy.

Adverse effects	Recommendations
Upper GI bleeding	• Prior to receiving DAPT, patients at high risk of GI bleeding can orally administer PPI to reduce the risk of bleeding.
	• In the event of GI bleeding, a high dose of PPI should be used and refer the patient to a gastroenterologist.
	• For severe GI bleeding, temporary discontinuation of antiplatelet agent can be considered.
	• When discontinuing DAPT is necessary, the treatment should be resumed as early as possible following endoscopic procedures.
Ecchymosis	• Diascopy (glass test) is used to determine whether the skin lesions are hemorrhagic.
	• Ecchymosis is a subcutaneous spot of bleeding arising as a result of old age, exposure to sunlight, bleeding disorder, or medication.
	• Ecchymosis is considered a mild side effect that usually can be resolved with supportive care.
Hematuria	• Development of hematuria in patients with DAPT still represents a high probability of urinary tract disease.
	• Urologist should be consulted, the cause of hematuria identified, and the appropriate treatment administered.
	• Hematuria is typically resolved following proper treatment.
Epistaxis	• Nosebleed is considered a mild side effect that can be controlled with adequate intervention.
	• Patients are strongly recommended to continue their DAPT for at least 12 months to maximize the benefits of antiplatelet therapy.
Dyspnea	• Medical conditions should be assessed before attributing dyspnea to ticagrelor.
	• Ticagrelor-induced dyspnea is generally mild in intensity, exerting no effect on the patient’s activities of daily life and can be resolved quickly.
	• Ticagrelor does not influence the patient’s cardiac and pulmonary function.
	• If persistent, severe dyspnea occurs, rendering patients unable to tolerate the discomfort, alternative regimen should be considered to replace ticagrelor.

DAPT, dual antiplatelet therapy; GI, gastrointestinal; PPI, proton-pump inhibitor.