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Rapid and sequential desensitization to both aspirin and clopidogrel
1Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia. sfernando@nsccahs.health.nsw.gov.au
Internal Medicine Journal
|August 20, 2010
Summary
Hypersensitivity to aspirin and clopidogrel necessitates desensitization therapy for patients needing stent implantation. This case study demonstrates successful rapid, sequential desensitization to both drugs, enabling dual anti-platelet therapy without adverse reactions.
Area of Science:
- Cardiology
- Immunology
- Neurology
Background:
- Dual anti-platelet therapy (DAPT) with aspirin and clopidogrel is crucial for preventing thrombosis after stent deployment in cardiovascular and cerebrovascular syndromes.
- Hypersensitivity reactions to aspirin (2.5%) and clopidogrel (1%) can complicate DAPT.
- Desensitization therapy may be required for patients with hypersensitivity to these agents undergoing stenting.
Observation:
- A 58-year-old woman experienced urticaria and angioedema after aspirin for ischemic cerebrovascular disease, followed by an identical reaction to clopidogrel.
- The patient required stent implantation for an internal carotid artery aneurysm.
Findings:
- Rapid desensitization to aspirin (5.5 hours) followed by rapid desensitization to clopidogrel (2.5 hours) was successfully performed sequentially before stenting.
- The patient tolerated DAPT for 4 months post-procedure without adverse reactions.
Implications:
- Rapid and sequential desensitization to both aspirin and clopidogrel is a viable strategy for patients requiring DAPT but with hypersensitivity to both agents.
- This approach can enable necessary stent implantation and long-term dual anti-platelet therapy in hypersensitive individuals.
- Successful desensitization expands treatment options for patients with complex cardiovascular and cerebrovascular conditions and drug allergies.
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