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Clopidogrel desensitization after drug-eluting stent placement
Karl F von Tiehl1, Matthew J Price, Rafael Valencia
1Division of Allergy, Asthma & Immunology, Scripps Clinic and Scripps Green Hospital, La Jolla, California, USA. vontiehl.karl@scrippshealth.org
Journal of the American College of Cardiology
|November 21, 2007
Summary
A standardized outpatient clopidogrel desensitization protocol is safe and effective for patients with suspected clopidogrel sensitivity. This approach helps prevent premature discontinuation of dual antiplatelet therapy after drug-eluting stent placement.
Area of Science:
- Cardiology
- Pharmacology
- Allergy and Immunology
Background:
- Adverse reactions to clopidogrel necessitate switching to ticlopidine, which has a more severe side-effect profile.
- Premature discontinuation of dual antiplatelet therapy after drug-eluting stent (DES) placement increases the risk of ischemic events.
Purpose of the Study:
- To evaluate the safety and efficacy of a standardized outpatient clopidogrel desensitization protocol.
- To determine if desensitization can enable patients to tolerate clopidogrel therapy, thereby avoiding ticlopidine.
Main Methods:
- A protocol involving escalating oral doses of clopidogrel in solution was used.
- Desensitization was performed on an outpatient basis, with follow-up at 2-4 weeks and 6 months.
- Success was defined as tolerating 75 mg of clopidogrel daily without adverse reactions.
Main Results:
- Twenty-four patients with suspected clopidogrel reactions after DES implantation were enrolled.
- Desensitization was acutely successful in all 24 patients, with only minor reactions in 5.
- At 6-month follow-up, 23 patients remained asymptomatic, demonstrating sustained efficacy.
Conclusions:
- Outpatient clopidogrel desensitization is a safe and effective strategy.
- The protocol induces sustained remission, allowing patients to continue essential dual antiplatelet therapy.
- This approach offers a significant advantage for outpatients at risk of premature dual antiplatelet therapy discontinuation.
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