Rapid Desensitization to Aspirin in Patients With Coronary Artery Disease: A Single Center Experience

Hernández, Berta Vega; Quintana, Roi Bangueses; Lampón, Beatriz Samaniego; Martínez-Luengas, Íñigo Lozano; Ortiz, Gaspar Gala; Salinas, Eduardo

doi:10.1016/j.rec.2016.04.023

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…Similar protocols were used by Dalmau and Hernandez on a further 5 and 12 patients respectively; all patients were successfully desensitized and 9 in total underwent PCI. 11,15 Of note, all desensitization procedures took place in the hospital setting and no patients with anaphylactoid reactions were included in any of these small studies. De Luca et al encountered 43 patients with aspirin hypersensitivity and desensitized 42 patients over 4.5 hours with 8 gradually increasing doses to 250 mg (1,2,4,8,16, 32 64, 128, 250 mg) although the reason for such a high final dose is not clear.…”

Section: Discussionmentioning

confidence: 99%

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

Jackson

Callaghan

Stapleton

et al. 2019

J Cardiovasc Pharmacol Ther

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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.

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Section: Discussionmentioning

confidence: 99%

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

Jackson

Callaghan

Stapleton

et al. 2019

J Cardiovasc Pharmacol Ther

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“…The features of different proposed protocols are displayed in Table 1 [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42].…”

Section: Overview Of Available Desensitization Protocolsmentioning

confidence: 99%

ASA Allergy and Desensitization Protocols in the Management of CAD: A Review of Literature

Verdoia,

Gioscia,

Nardin

et al. 2023

JCM

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Acetylsalicylic acid (ASA) hypersensitivity still represents one of the major deals for patients with atherosclerotic cardiovascular disease (ASHD), especially for those requiring percutaneous coronary interventions in the absence of validated alternative options. Despite symptoms after ASA administration being reported in 6–20% of cases, true ASA allergy only represents a minority of the patients, pointing to the importance of challenge tests and potential strategies for tolerance induction. ASA desensitization protocols were proposed several decades ago, with accumulating the literature on their use in patients undergoing PCI either for chronic disease or acute coronary syndromes. Nevertheless, the promising results of the studies and meta-analyses have not been validated so far by the support of large-scale randomized trials or unique indications from guidelines. Therefore, ASA desensitization is still largely unapplied, leaving the management of ASA hypersensitivity to the individualized approach of cardiologists.

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“…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%

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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Rapid Desensitization to Aspirin in Patients With Coronary Artery Disease: A Single Center Experience

Cited by 6 publications

References 6 publications

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

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

ASA Allergy and Desensitization Protocols in the Management of CAD: A Review of Literature

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

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