Desensitization for the management of clopidogrel hypersensitivity: initial clinical experience

Platelet activation and aggregation play an important role in the pathogenesis of arterial thrombosis in coronary, cerebral and peripheral vascular beds. The antiplatelet agent clopidogrel has become a mainstay of treatment for patients with acute coronary syndromes and stroke, and to reduce ischemic complications after percutaneous coronary and peripheral interventions. There are, however, increasing numbers of reports of hypersensitivity reactions to clopidogrel. We present here a protocol for clopidogrel desensitization in isolated cutaneous reactions. Eight patients have completed the protocol successfully. Three subsequently underwent coronary intervention, and all are currently tolerating a daily clopidogrel dose a median of 7.5 months after desensitization. Desensitization may allow for the safe use of clopidogrel in patients with a history of prior cutaneous hypersensitivity reactions.