Catastrophic early drug eluting stents thrombosis and aspirin hypersensitivity

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a common procedure.
• Stent thrombosis, a serious complication, can occur early or late after DES implantation.
• Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is standard post-PCI, but aspirin allergy poses a challenge.

Observation:

• A 79-year-old Italian woman presented with a history of aspirin hypersensitivity.
• She underwent a procedure requiring DAPT, including aspirin, due to cardiologic indications.
• The patient experienced catastrophic early drug-eluting stent thrombosis.

Findings:

• This case demonstrates a severe adverse event in a patient with aspirin allergy on DAPT.
• Early stent thrombosis occurred despite standard antithrombotic regimens, complicated by aspirin hypersensitivity.
• The clinical scenario underscores the difficulties in managing anticoagulation in such patients.

Implications:

• Managing aspirin-hypersensitive patients undergoing PCI requires careful consideration of antithrombotic strategies.
• Alternative antiplatelet regimens may be necessary to mitigate the risk of stent thrombosis.
• Further research is needed to optimize DAPT protocols for patients with drug allergies.