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Triflusal in Patients with Acute Coronary Syndrome and Acetylsalicylic Acid Hypersensitivity
Georgina Fuertes Ferre1, Ainhoa Pérez Guerrero2, Jose Antonio Linares Vicente3
1Department of Cardiology, Miguel Servet University Hospital, Zaragoza, Spain, georginaff@hotmail.com.
Insights
Triflusal is a safe and effective alternative for patients with acute coronary syndrome and aspirin hypersensitivity, demonstrating good tolerability and low rates of cardiovascular and bleeding events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Acetylsalicylic acid hypersensitivity (ASAH) poses challenges for managing acute coronary syndrome (ACS) patients requiring dual antiplatelet therapy (DAPT).
- Evaluating triflusal as an alternative antiplatelet agent in ACS patients with ASAH is crucial for expanding therapeutic options.
Discussion:
- Triflusal was well-tolerated in ACS patients with ASAH, with no reported adverse reactions.
- The study observed low rates of cardiovascular events, including mortality, myocardial infarction, and ischemic stroke, during a median follow-up of over 5 years.
- A low incidence of significant bleeding events (BARC grade ≥2) was noted, suggesting a favorable bleeding profile.
Key Insights:
- Triflusal is a viable and safe alternative antiplatelet therapy for patients with ACS and ASAH.
- The drug demonstrated efficacy in preventing major adverse cardiovascular events in this high-risk population.
- Low bleeding risk associated with triflusal is a significant advantage in patients requiring DAPT.
Outlook:
- Further prospective studies are warranted to confirm these findings in a larger cohort.
- Triflusal may represent an important therapeutic option for ACS patients with aspirin intolerance.
- Long-term data on triflusal use in ACS with ASAH could refine clinical practice guidelines.
Background:
Acetylsalicylic acid hypersensitivity (ASAH) limits therapeutic options in patients with acute coronary syndrome (ACS), who benefit from dual antiplatelet therapy (DAPT), especially when undergoing stent implantation. Our aim was to evaluate the safety and efficacy of triflusal in patients with ACS and ASAH.
Methods And Results:
Two-center retrospective study of patients diagnosed with ACS and ASAH from January 1, 2000, to May 1, 2020. Sixty-six patients were treated with triflusal. ASAH was confirmed with tests in 15 patients (22.7%). Forty-nine patients (74.2%) presented history of other drug allergies. Fifty-nine patients (89.4%) underwent stent implantation. DAPT was prescribed for ≥12 months in 54 patients. No adverse reactions to triflusal were reported. During a median follow-up of 5.12 years [IQR 2.7-9.9], rate of cardiovascular (CV) mortality was 6.1%, nonfatal myocardial infarction 12.1%, and ischemic stroke 4.5%. No cases of definite stent thrombosis occurred. Bleeding Academic Research Consortium grade ≥2 was observed in 3 patients during follow-up.
Conclusion:
In this series of patients presenting with ACS and ASA hypersensitivity, triflusal showed good tolerability and was associated with a low rate of CV and bleeding events.
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