Clopidogrel Hypersensitivity: A Novel Multi-Day Outpatient Oral Desensitization Regimen

Fajt, Merritt L.; Petrov, Andrej A.

doi:10.1345/aph.1m379

Cited by 17 publications

(11 citation statements)

References 43 publications

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“…Hypersensitivity may manifest as generalized, localized, or systemic reactions. Evidence suggests that the majority of patients with hypersensitivity reactions will present with generalized, cutaneous symptoms [6,7]. These generalized reactions may be an erythematous, maculopapular rash that is pruritic or urticaria without mucosal involvement [6].…”

Section: Presentation Of Hypersensitivitymentioning

confidence: 99%

“…Evidence suggests that the majority of patients with hypersensitivity reactions will present with generalized, cutaneous symptoms [6,7]. These generalized reactions may be an erythematous, maculopapular rash that is pruritic or urticaria without mucosal involvement [6]. Rashes are typically distributed throughout the trunk and may involve upper and/or lower extremities [7,8].…”

Section: Presentation Of Hypersensitivitymentioning

confidence: 99%

“…While this approach appears successful, the majority of patients were admitted as intensive care unit patients. Total cost and overall healthcare utilization must be considered when evaluating the clinical applicability and feasibility of desensitization regimens [6].…”

Section: Desensitizationmentioning

confidence: 99%

“…In an effort to prevent the need for admission, a novel, multi-day outpatient regimen was developed and reported in a case-series of eight patients [6]. Of the eight patients, seven demonstrated cutaneous reactions, while one patient had angioedema.…”

Section: Desensitizationmentioning

confidence: 99%

“…In addition to revealing a statistically significant reduction in & Craig J. Beavers craig.beaverspharmd@gmail.com ischemic events with clopidogrel, investigators also reported a hypersensitivity reaction (rash) in 6.02 % of patients [1]. Subsequent data have confirmed this adverse reaction and described a hypersensitivity rate of approximately 4 % [6]. With the established benefits and numerous indications for clopidogrel therapy, practitioners face a challenge when managing patients that develop this reaction.…”

Section: Introductionmentioning

confidence: 99%

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Management Strategies for Clopidogrel Hypersensitivity

Beavers

Carris

Ruf

2015

Drugs

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Clopidogrel is a cornerstone of dual antiplatelet therapy. Hypersensitivity reactions potentially limit the use of this treatment and present a significant clinical challenge. The authors have developed recommendations for the management of clopidogrel hypersensitivity with consideration for the etiology, pathophysiology, and critical evaluation of potential management strategies. The clopidogrel hypersensitivity reaction is complex in mechanism and presents generally around day 5 of treatment. Generalized reactions are most common, but the reaction may also be localized or systemic. Screening patients for hypersensitivity is not always possible because the type IV delayed reaction is not detected reliably by conventional skin prick, intradermal challenge, or patch testing. Proposed strategies for management of clopidogrel hypersensitivity include treatment of the reaction with corticosteroids, clopidogrel desensitization, substituting an alternative P2Y12 inhibitor, or clopidogrel avoidance. The safety, efficacy, and cost of each potential strategy must be considered when managing a patient with clopidogrel hypersensitivity.

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Section: Presentation Of Hypersensitivitymentioning

confidence: 99%

Section: Presentation Of Hypersensitivitymentioning

confidence: 99%

Section: Desensitizationmentioning

confidence: 99%

Section: Desensitizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management Strategies for Clopidogrel Hypersensitivity

Beavers

Carris

Ruf

2015

Drugs

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Current awareness: Pharmacoepidemiology and drug safety

2010

Pharmacoepidem. Drug Safe.

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Allergic Reactions to Clopidogrel and Cross-Reactivity to Other Agents

Lokhandwala

Best

Henry

et al. 2010

Curr Allergy Asthma Rep

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Clopidogrel is a widely used antiplatelet agent, particularly after coronary stent implantation. About 1% of patients have allergic or hematologic adverse reactions to clopidogrel. This has important therapeutic implications, as premature discontinuation of clopidogrel is the strongest risk factor for stent thrombosis. Clopidogrel allergy most commonly manifests as a rash. It is important to distinguish this from other causes of rash occurring in patients who have had a recent coronary stent. Although antihistamines and short-term oral corticosteroids are effective in treating most clopidogrel hypersensitivity reactions, some persistent reactions may require discontinuation of clopidogrel. When discontinuation of clopidogrel is required, substitution with an alternative thienopyridine such as ticlopidine traditionally has been performed. However, a recent study suggests that there may be as high as a 27% risk of recurrence of non-life-threatening allergic reactions in such patients, which are usually similar to the allergic reactions that occurred with clopidogrel. No data are available regarding the frequency of cross-reactivity to prasugrel and ticagrelor; these may be potential therapeutic options in some patients.

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Clopidogrel Hypersensitivity: A Novel Multi-Day Outpatient Oral Desensitization Regimen

Cited by 17 publications

References 43 publications

Management Strategies for Clopidogrel Hypersensitivity

Management Strategies for Clopidogrel Hypersensitivity

Current awareness: Pharmacoepidemiology and drug safety

Allergic Reactions to Clopidogrel and Cross-Reactivity to Other Agents

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