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Characterization of aspirin allergies in patients with coronary artery disease

Charles H Feng1, Andrew A White, Donald D Stevenson

  • 1Department of Internal Medicine, Scripps Green Hospital, La Jolla, California, USA. cfeng622@gmail.com

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|January 29, 2013
PubMed

Insights

Aspirin reactions are uncommon in coronary artery disease (CAD) patients. Many patients with aspirin intolerance can safely resume aspirin therapy for cardiovascular prophylaxis, but this is underutilized.

Area of Science:

  • Cardiology
  • Clinical Pharmacology
  • Immunology

Background:

  • Aspirin is crucial for cardiovascular prophylaxis, preventing coronary thrombosis.
  • Patients with a history of aspirin reactions are often excluded from this therapy.
  • Understanding the nature and management of aspirin reactions in cardiovascular disease is essential.

Purpose of the Study:

  • To characterize the clinical presentation of patients with coronary artery disease (CAD) and a history of aspirin reactions.
  • To assess the frequency and types of aspirin reactions in CAD patients.
  • To evaluate the underutilization of aspirin therapy and alternative strategies in this population.

Main Methods:

  • Retrospective analysis of patient data from a county-wide health care system (2009-2012).
  • Inclusion criteria: patients with CAD and a prior history of aspirin reactions.
  • Data collected on reaction types, current aspirin use, and alternative antiplatelet therapies.

Main Results:

  • 142 out of 9,565 CAD patients (1.5%) had a history of aspirin reactions.
  • 21% of these reactions were consistent with cutaneous/respiratory hypersensitivity; others were mainly gastrointestinal intolerance or bleeding.
  • Only 24% of patients with a history of reactions were on aspirin for cardiovascular prophylaxis; 17.6% of those not on aspirin received clopidogrel.

Conclusions:

  • Aspirin reactions are infrequent in CAD patients.
  • Patients with hypersensitivity can undergo desensitization; those with gastric intolerance can often be managed with proton pump inhibitors.
  • Effective strategies to restore aspirin prophylaxis are underused in this patient group.
Abstract

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