Aspirin desensitisation for Chinese patients with coronary artery disease

Abstract

Objective To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease. Design Case series.Setting A regional hospital in Hong Kong.Patients Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal antiinflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012.Results There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt.No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation. ConclusionGiven the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.

Clinical approach on challenge and desensitization procedures with aspirin in patients with ischemic heart disease and nonsteroidal anti-inflammatory drug hypersensitivity

“…It also does not explain the clinical indications for when to use the tolerance (challenge) test or, instead, desensitization to ASA. In particular, the published series differ in terms of number of patients studied, antihistamine premedication, intervals between ASA doses, total time of administration, cumulative dose reached and time of observation after procedure is finished (Table ).…”

“…On the basis of the analysis of the data on ASA challenges and desensitizations collected in the first phase of the study, as well as of literature data and the expert panel opinion, there was a consensus that the access to procedures of both challenge and desensitization should be implemented in every clinical subset of acute hypersensitivity to NSAIDs provided by the position paper on ‘Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti‐inflammatory drugs’ . Moreover, there was a consensus that the challenge procedure is safe and has to be implemented in patients with stable CIHD and a history of hypersensitivity to ASA at an anti‐inflammatory dose (over 300 mg), as well as at an antiplatelet dose (75–100 mg), and nonsevere clinical symptoms (e.g.…”

“…It was agreed that patients with NERD and NECD generally need a desensitization procedure with longer intervals between the doses to reach the cumulative dose . However, such longer intervals are impractical for subjects with unstable CAD .…”

Rapid Desensitization in Immediate Hypersensitivity Reaction to Drugs

“…There are many protocols of RDD to ASA for CVD or NVD, starting from 1 to 5 mg and achieving doses as 75 to 325 mg per day [64][65][66][67]. It is important to establish with the patient's physician which dose he desires to achieve before designing the protocol.…”

“…It is still controversial if ACE inhibitors and beta-blockers should be withheld before the ASA-DST, because of their benefits in vascular diseases. Thus, the use of antihistamines and corticosteroids as premedication is controversial, oppositely to NERD/AERD, for which patients must be treated with leukotriene modifiers and with asthma/rhinosinusitis drugs [66][67][68]. Finally, once the final therapeutic ASA antiplatelet dose is reached, it should not be interrupted in order to maintain aspirin tolerance.…”