Meta-Analysis of Acetylsalicylic Acid Desensitization in Patients With Acute Coronary Syndrome

Chopra, Amitabh Madhukumar; Díez‐Villanueva, Pablo; Córdoba-Soriano, Juan G.; Lee, Joe K.T.; Al‐Ahmad, Mona; Ferraris, Victor A.; Mehta, Monik; Kowalski, Marek L.

doi:10.1016/j.amjcard.2019.03.047

Cited by 13 publications

(10 citation statements)

References 26 publications

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“…In the last few years, several rapid protocols have been applied oftentimes, demonstrating favorable efficacy and safety outcomes (3, 6, 9-11, 14, 15, 17-21). A recent metanalysis of 15 studies which included a total of 691 patients presenting with coronary artery disease and history of ASA hypersensitivity who underwent ASA RD protocols reported high pooled protocol success rates among these patients (98.3 [97.2 to 99.5]%) with zero hypersensitivity reactions at follow-up (between 1 and 46 months, mode 12 months) (16). The cumulative adverse events rate was 8.4% (3.2 to 13.6) and included cardiac deaths, heart failure, gastrointestinal bleeding and events requiring repeat PCI, thrombolysis, and CABG procedures (16).…”

Section: Discussionmentioning

confidence: 99%

“…A recent metanalysis of 15 studies which included a total of 691 patients presenting with coronary artery disease and history of ASA hypersensitivity who underwent ASA RD protocols reported high pooled protocol success rates among these patients (98.3 [97.2 to 99.5]%) with zero hypersensitivity reactions at follow-up (between 1 and 46 months, mode 12 months) (16). The cumulative adverse events rate was 8.4% (3.2 to 13.6) and included cardiac deaths, heart failure, gastrointestinal bleeding and events requiring repeat PCI, thrombolysis, and CABG procedures (16). However, one important limitation of this metanalysis was the retrospective, nonrandomized, small cohort nature of the vast majority of the clinical literature available on ASA desensitization for these patients.…”

Section: Discussionmentioning

confidence: 99%

“…There are several ASA desensitization protocols available, although in the context of ischemic heart disease rapid desensitization protocols are preferred, as they are completed in a few hours with reported success rates above 90% and favorable safety outcomes (3,7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Concerning the timing of ASA desensitization, current practice European guidelines recommend to perform the procedure before coronary angiography except for urgent situations, such as ST-segment elevation myocardial infarction (STEMI), where in order to avoid further myocardial damage, the temporary use of an alternative antiplatelet drug (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Rapid desensitization to acetylsalicylic acid in patients with ischemic heart disease: 10-year experience of a Portuguese Allergy Department

Brás

Caiado

Pedro

2023

Eur Ann Allergy Clin Immunol

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Introduction: Managing Acetylsalicylic Acid (ASA) hypersensitivity (HS) in patients with ischemic heart disease (IHD) is a challenge. Data on Rapid Desensitization (RD) to ASA is scarce. We aimed to report the outcomes of our 10-year experience with RD to ASA.Methods: Retrospective, observational, single-center study of patients with ASA HS and suspected IHD who underwent RD to ASA between March 2009 and February 2019.Results: Fifty patients were included. ASA HS presentation ranged from urticaria (56%) to anaphylaxis (32%). Regarding cardiologic diagnoses, 40 patients (80%) had acute coronary syndrome and 10 (20%) stable angina. The majority of patients (N=36; 72%) underwent percutaneous coronary intervention. RD to ASA was successful in all patients. Two patients presented a mild HS reaction during the RD, which was promptly treated, and subsequent daily doses of ASA 100mg were tolerated. Conclusions:In our cohort, RD to ASA in patients with ASA HS and IHD was very effective and safe.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rapid desensitization to acetylsalicylic acid in patients with ischemic heart disease: 10-year experience of a Portuguese Allergy Department

Brás

Caiado

Pedro

2023

Eur Ann Allergy Clin Immunol

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“…In Singapore General Hospital (SGH), aspirin desensitization consists of 11 steps, with aspirin doses administered in intervals of 20 to 30 minutes ( Supplementary material 1 ). This strategy of desensitizing patients to aspirin has been shown to be effective in those with CAD [ 11 12 13 ]. Specifically, aspirin desensitization has been reported to allow >90% of patients with cardiovascular indication for aspirin to achieve tolerance to this medication [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Patient characterization and predictors of aspirin desensitization response

Cheong

Tan

Lim

et al. 2021

Asia Pacific Allergy

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Background Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) may limit the use of aspirin in patients with cardiovascular diseases. Aspirin desensitization, which is a resource-intensive process, can offer such patients access to aspirin through the induction of temporary tolerance to aspirin. However, there is limited information on aspirin desensitization response in patients undergoing aspirin desensitization for cardiac indications in Asia. Objective To characterize patients who have undergone aspirin desensitization, evaluate their responses to the procedure, and identify risk factor(s) associated with failure of aspirin desensitization. Methods We conducted a retrospective review of medical records of patients who underwent aspirin desensitization in Singapore General Hospital between 1 June 2014 and 31 October 2017. Chi-square or Fisher exact test were used to analyze categorical data while independent samples t test or Wilcoxon rank-sum test were used for continuous data where appropriate. Multivariate logistic regression was used to identify predictors of aspirin desensitization failure. Results All 214 patients in our study had cardiovascular indications for aspirin, with angioedema being the most common type of index reaction experienced with NSAIDs (n = 104, 48.6%). One hundred sixty-five patients (77.1%) achieved successful aspirin desensitization. In the selected sample analysis of patients with true NSAID hypersensitivity (n = 163), an index reaction of angioedema to NSAIDs was found to be significantly associated with a higher risk of failing aspirin desensitization (odds ratio, 7.21; 95% confidence interval, 1.94–26.71). Conclusion Majority of the patients who underwent aspirin desensitization in our institution were able to achieve tolerance to aspirin. An index reaction of angioedema to NSAIDs was identified as a risk factor for aspirin desensitization failure. This information can aid in the risk stratification of patients undergoing aspirin desensitization and ensure efficient resource allocation for this procedure.

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“…Acetylsalicylic acid hypersensitivity (ASAH) presents a substantial problem in patients with acute coronary syndrome (ACS) in whom dual antiplatelet therapy (DAPT) is usually highly recommended and mandatory when undergoing coronary stent implantation. ASA desensitization has become the preferred strategy to manage patients with coronary artery disease (CAD) and ASAH [1,2]. However, desensitization may not always be feasible, such as in those cases with hemodynamic instability or prior Cardiology 2021;146:426-430 DOI: 10.1159/000514414 severe adverse reactions.…”

Section: Introductionmentioning

confidence: 99%

Triflusal in Patients with Acute Coronary Syndrome and Acetylsalicylic Acid Hypersensitivity

et al. 2021

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Background: Acetylsalicylic acid hypersensitivity (ASAH) limits therapeutic options in patients with acute coronary syndrome (ACS), who benefit from dual antiplatelet therapy (DAPT), especially when undergoing stent implantation. Our aim was to evaluate the safety and efficacy of triflusal in patients with ACS and ASAH. Methods and Results: Two-center retrospective study of patients diagnosed with ACS and ASAH from January 1, 2000, to May 1, 2020. Sixty-six patients were treated with triflusal. ASAH was confirmed with tests in 15 patients (22.7%). Forty-nine patients (74.2%) presented history of other drug allergies. Fifty-nine patients (89.4%) underwent stent implantation. DAPT was prescribed for ≥12 months in 54 patients. No adverse reactions to triflusal were reported. During a median follow-up of 5.12 years [IQR 2.7–9.9], rate of cardiovascular (CV) mortality was 6.1%, nonfatal myocardial infarction 12.1%, and ischemic stroke 4.5%. No cases of definite stent thrombosis occurred. Bleeding Academic Research Consortium grade ≥2 was observed in 3 patients during follow-up. Conclusion: In this series of patients presenting with ACS and ASA hypersensitivity, triflusal showed good tolerability and was associated with a low rate of CV and bleeding events.

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Meta-Analysis of Acetylsalicylic Acid Desensitization in Patients With Acute Coronary Syndrome

Cited by 13 publications

References 26 publications

Rapid desensitization to acetylsalicylic acid in patients with ischemic heart disease: 10-year experience of a Portuguese Allergy Department

Rapid desensitization to acetylsalicylic acid in patients with ischemic heart disease: 10-year experience of a Portuguese Allergy Department

Patient characterization and predictors of aspirin desensitization response

Triflusal in Patients with Acute Coronary Syndrome and Acetylsalicylic Acid Hypersensitivity

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