Rapid Aspirin Desensitization is Safe and Feasible in Patients With Stable and Unstable Coronary Artery Disease: A Single-Center Experience.

Abstract

AIMS:

There are limited data on aspirin (ASA) desensitization for patients with coronary disease. We present our experience with a rapid nurse-led oral desensitization regimen in patients with aspirin sensitivity undergoing coronary angiography.

METHODS:

This single-center retrospective observational study includes patients with a history of ASA sensitivity undergoing coronary angiography with intent to perform percutaneous coronary intervention (PCI).

RESULTS:

Between January 2012 and January 2017, 24 patients undergoing coronary angiography for stable coronary disease (7 cases) or acute coronary syndromes (non-ST-segment myocardial infarction [NSTEMI; 8 cases], STEMI [9 cases]) underwent aspirin desensitization having reported previous reactions to aspirin. At initial presentation, previous sensitivity reactions were reported as: mucocutaneous reactions in 17 patients (urticaria in 3 [13%], nonurticarial rash in 6 [25%], angio-oedema in 8 [33%]), respiratory sensitivity in 4 (17%), and systemic anaphylactoid reactions in 3 (13%). Seventeen (71%) patients underwent PCI. Desensitization was acutely successful in 22 (92%) patients and unsuccessful in 2 (8%) patients who both had a single short-lived episode of acute bronchospasm treated successfully with nebulized salbutamol. Fifteen successfully desensitized patients completed 12 months of aspirin; no patient had recurrent hypersensitivity reaction. Aspirin was stopped prior to 12 months in 7 patients (replaced by warfarin [1 case], no antiplatelet or single antiplatelet clinically indicated and clopidogrel chosen [4 cases], patient choice without evidence of recurrent hypersensitivity [1 case], and death due to cardiogenic shock following STEMI [1 case]).

CONCLUSION:

A rapid aspirin desensitization protocol is safe and effective across a broad spectrum of hypersensitivity reactions and clinical presentations.

• Authors: Matthew Jackson, Sarah Callaghan, John Stapleton, Sarah Bolton, David Austin, Douglas F Muir, Andrew G C Sutton, Robert A Wright, Paul D Williams, Jim A Hall, Justin Carter, Mark A de Belder, Neil Swanson
• Journal: Journal of cardiovascular pharmacology and therapeutics (J Cardiovasc Pharmacol Ther) Vol. 24 Issue 4 Pg. 359-364 (07 2019) ISSN: 1940-4034 [Electronic] United States
• PMID: 30614246 (Publication Type: Journal Article, Observational Study)

Chemical References

• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Acute Coronary Syndrome (diagnostic imaging, therapy)
• Aged
• Aged, 80 and over
• Aspirin (administration & dosage, adverse effects, immunology)
• Desensitization, Immunologic (adverse effects, nursing)
• Drug Hypersensitivity (diagnosis, immunology, prevention & control)
• Female
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction (diagnostic imaging, therapy)
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects, immunology)
• Retrospective Studies
• ST Elevation Myocardial Infarction (diagnostic imaging, therapy)
• Time Factors
• Treatment Outcome