Fast-Track Aspirin Odyssey: ICU Chronicles

Aspirin is used in patients with coronary artery disease essential in both acute and chronic phases of treatment, especially post-catheterization and post-coronary artery stent placement. Some patients have sensitivity to aspirin. Hypersensitivity reaction symptoms include itchy and watery eyes, itchy rash, worsening asthma, wheezing to fatal angioedema, and anaphylaxis. In such cases, clopidogrel can be used instead of aspirin if it is necessary to avoid the use of aspirin. Alternatively, we can try desensitization to aspirin. In aspirin desensitization, incremental doses of aspirin are provided at fixed time intervals. It usually lasts between one and three days. These protocols are often impractical in emergent conditions, especially in conditions where percutaneous coronary intervention (PCI) reveals coronary artery stenosis requiring stent placement. Post-stent placement long-term treatment with aspirin is needed. This has led to limited application in clinical practice despite the potential benefits. We present a case of a patient who presented to us with complaints of shortness of breath and intermittent chest pain. A thorough evaluation was conducted, including cardiac catheterization, which revealed a 70% blockage in the right coronary artery (RCA) and a 65% blockage in the left anterior descending (LAD) artery, necessitating stent placement. The patient reported a severe allergy to aspirin, requiring aspirin desensitization. Rapid aspirin desensitization was successfully performed in the ICU, taking two hours and 15 minutes. The patient underwent PCI and stent placement in the RCA the following day. She is currently on dual antiplatelet therapy with aspirin and clopidogrel and has scheduled follow-ups with both a cardiologist and an allergist.