Aspirin Hypersensitivity in Patients With Atherosclerotic Cardiovascular Disease

Area of Science:

• Cardiology
• Clinical Immunology
• Pharmacology

Background:

• Low-dose aspirin is a cornerstone antiplatelet therapy for atherosclerotic cardiovascular disease (ASCVD).
• Aspirin hypersensitivity affects 1-5% of patients, complicating ASCVD management and often being misdiagnosed as intolerance.
• Lack of clear guidelines for aspirin-hypersensitive patients necessitates alternative strategies.

Purpose of the Study:

• To clarify the distinction between aspirin hypersensitivity and intolerance.
• To discuss effective management strategies, including aspirin desensitization and challenge, for patients with ASCVD requiring aspirin therapy.
• To provide practical algorithms for managing aspirin hypersensitivity in ASCVD.

Main Methods:

• Review of pathophysiological mechanisms and classification of aspirin hypersensitivity.
• Analysis of existing literature on aspirin desensitization and aspirin challenge protocols.
• Discussion of alternative antiplatelet agents and clinical management algorithms.

Main Results:

• Aspirin desensitization and low-dose aspirin challenge are pragmatic, safe, and effective in managing aspirin hypersensitivity in ASCVD patients.
• These methods are systematically underused in clinical practice.
• Confusion persists regarding appropriate alternative antiplatelet therapies.

Conclusions:

• Distinguishing aspirin hypersensitivity from intolerance is crucial for appropriate patient management.
• Aspirin desensitization and challenge offer viable solutions for ASCVD patients needing aspirin therapy despite hypersensitivity.
• Further education and implementation of standardized protocols are needed to improve the care of these patients.