Efficacy and Safety of Available Protocols for Aspirin Hypersensitivity for Patients Undergoing Percutaneous Coronary Intervention

Bianco, Matteo; Bernardi, Alessandro; D’Ascenzo, Fabrizio; Cerrato, Enrico; Omedè, Pierluigi; Montefusco, Antonio; DiNicolantonio, James J.; Biondi‐Zoccai, Giuseppe; Varbella, Ferdinando; Carini, Giovanni; Moretti, Claudio; Pozzi, Roberto; Gaïta, Fiorenzo

doi:10.1161/circinterventions.115.002896

Cited by 28 publications

(19 citation statements)

References 34 publications

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“…4 Despite the availability of disparate ASA desensitization protocols, 7,10-12 these are not commonly used in real-world practice. 6 Indeed, the fact that these may be time-consuming potential leading to treatment delays are potential causes for physicians to not embrace these protocols particularly in settings such as the treatment of patients with CAD. In patients with ASA hypersensitivity and concomitant CAD, data on the safety and efficacy of desensitization therapy are limited to small case series.…”

Section: Discussionmentioning

confidence: 99%

“…Desensitization protocols generally involve gradual increases in patient exposure to ASA with the goal of mitigating or abolishing immune-mediated reaction. 4,6 However, many desensitization protocols require several days to be completed, making them unpractical. This may also contribute to the limited experience with applying ASA desensitization protocols in real-world practice in patients with CAD.…”

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confidence: 99%

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Aspirin Desensitization in Patients With Coronary Artery Disease

Rossini

Iorio

Pozzi

et al. 2017

Circ: Cardiovascular Interventions

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A spirin (ASA) is the cornerstone of antithrombotic therapy in patients with coronary artery disease (CAD), both in the acute and the chronic phase of treatment.1-3 However, ≈2% of patients have hypersensitivity to ASA. 4 Although See Editorial by Tantry and Gurbelclopidogrel is recommended in practice guidelines as the antiplatelet agent of choice for patients who are unable toBackground-There are limited data on aspirin (ASA) desensitization for patients with coronary artery disease. The aim of the present study was to assess the safety and efficacy of a standard rapid desensitization protocol in patients with ASA sensitivity undergoing coronary angiography. Methods and Results-This is a prospective, multicenter, observational study including 7 Italian centers including patients with a history of ASA sensitivity undergoing coronary angiography with intent to undergo percutaneous coronary intervention. A total of 330 patients with history of ASA sensitivity with known/suspected stable coronary artery disease or presenting with an acute coronary syndrome, including ST-segment-elevation myocardial infarction were enrolled. Adverse effects to aspirin included urticaria (n=177, 53.6%), angioedema (n=69, 20.9%), asthma (n=65, 19.7%), and anaphylactic reaction (n=19, 5.8%). Among patients with urticaria/angioedema, 13 patients (3.9%) had a history of idiopathic chronic urticaria. All patients underwent a rapid ASA (5.5 hours) desensitization procedure. The desensitization procedure was performed before cardiac catheterization in all patients, except for those (n=78, 23.6%) presenting with ST-segment-elevation myocardial infarction who underwent the desensitization after primary percutaneous coronary intervention. Percutaneous coronary intervention was performed in 235 patients (71%) of the overall study population. The desensitization procedure was successful in 315 patients (95.4%) and in all patients with a history of anaphylactic reaction. Among the 15 patients (4.6%) who did not successfully respond to the desensitization protocol, adverse reactions were minor and responded to treatment with corticosteroids and antihistamines. Among patients with successful in-hospital ASA desensitization, 253 patients (80.3%) continued ASA for at least 12 months. Discontinuation of ASA in the 62 patients (19.7%) who had responded to the desensitization protocol was because of medical decision and not because of hypersensitivity reactions. Conclusions-A standard rapid desensitization protocol is safe and effective across a broad spectrum of patients, irrespective of the type of aspirin sensitivity manifestation, with indications to undergo coronary angiography with intent to perform percutaneous coronary intervention. Rossini et al Antiplatelet Desensitization Registrytake aspirin because of hypersensitivity or intolerance, ASA desensitization also represents an alternative approach. 5 This is particularly relevant for patients requiring dual antiplatelet therapy, including ASA and a P2Y 12 receptor, such as in patients experien...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Aspirin Desensitization in Patients With Coronary Artery Disease

Rossini

Iorio

Pozzi

et al. 2017

Circ: Cardiovascular Interventions

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“…However, in a recent systematic review survey [32], a surprising 56% of cardiologists do not perform challenge or desensitization procedures, but manage ASA hypersensitivity using alternative treatments. The most common monotherapy in this survey was clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

Al‐Ahmad

Rodriguez-Bouza

Nurkic

2018

Int Arch Allergy Immunol

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Background: A history of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with cross-intolerance to several drugs is common in some patients with coronary artery disease. We present a series of patients with acute coronary syndrome undergoing ASA desensitization prior to a possible stent to evaluate the short- and long-term efficacy and safety. The aim was to evaluate the outcomes of an ASA desensitization protocol developed by our center based on the guidelines proposed by the EAACI drug allergy expert recommendations. Methods: We developed a desensitization protocol that was based on both the patient characteristics and onset of reaction after NSAIDs, including premedication with a leukotriene antagonist and the H1-antagonist antihistamine. The clinical entities were NSAID-induced urticaria and/or angioedema in the absence of chronic spontaneous urticaria (NIUA) and NSAID-exacerbated respiratory disease (NERD). Results: A total of 23 patients were challenged or desensitized with ASA: 19 NIUA and 4 NERD. All patients tolerated the protocol at the different times of 30, 45, 90, and 120 min. The dosages of oral ASA that were given included 10, 21, 41, 81, and 162 mg (cumulative dose 315 mg). One patient reacted during the procedure and 1 during follow-up. Symptoms were limited to the skin without manifestations in other organs. All patients tolerated the required dose of ASA within 30–120 min. Those requiring urgent catheterization were desensitized within 90 min. Conclusions: Our protocol addresses challenge or desensitization with the contribution of a specialist allergist. It provides an effective, dynamic, safe, and short administration of 81 mg or higher of ASA in patients with a history of NSAID hypersensitivity with skin involvement.

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“…This data has been confirmed by many observational studies, which have revealed a prevalence between 2.6% and 3.1%. 25 The mechanism underlying aspirin hypersensitivity reactions can be either immunological or pharmacological; however, some patients could have both reactions. Allergic/immunological reactions are due to a specific immunologlobulin E (IgE) produced against the drug, whereas pharmacological reactions are mediated by inhibition of the COX-1 pathway.…”

Section: Management Of Aspirin-intolerant Patientsmentioning

confidence: 99%

“…Once the desensitization protocol is completed, it is important to keep on assuming aspirin and not to interrupt it for more than 5 days in a row; otherwise, the upregulation of leukotriene receptors will make another desensitization procedure necessary (Table 2). 25 The ADAPTED Registry was the largest study exploring the systematic use of ASA desensitization in a large cohort of patients with CAD, both acute and stable, undergoing invasive evaluation with the intent to undergo PCI. A total of 330 patients were enrolled, including high coronary risk patients, such as patients with STEMI, and those who had a history of severe anaphylactic reactions, such as anaphylactic shock.…”

Section: Management Of Aspirin-intolerant Patientsmentioning

confidence: 99%

Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With Coronary Artery Disease? An Historical and Practical Narrative Review

et al. 2017

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Efficacy and Safety of Available Protocols for Aspirin Hypersensitivity for Patients Undergoing Percutaneous Coronary Intervention

Abstract: Available protocols for aspirin hypersensitivity are effective and safe, representing a feasible approach for patients needing dual antiplatelet therapy.

Cited by 28 publications

References 34 publications

Aspirin Desensitization in Patients With Coronary Artery Disease

Aspirin Desensitization in Patients With Coronary Artery Disease

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With Coronary Artery Disease? An Historical and Practical Narrative Review

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