Original Title: Efficacy and Safety of Available Protocols for Aspirin Hypersensitivity for Patients Undergoing Percutaneous Coronary Intervention. A Survey and Systematic Review. Reference: Bianco M et al. Circ Cardiovasc Interv. 2016 Jan;9(1):e002896.
The follow up strategy for aspirin hypersensitive patients undergoing PCI remains unclear.
A systematic search included 283 patients from 11 studies. Primary end point was discharge with aspirin, while adverse events rate was the secondary end point.
Only one of the studies performed an endovenous desensitization protocol that was highly effective (98%) and saw few adverse events, compared to the rest of protocols with oral administration of escalating doses of aspirin.
There were no significant differences among the oral desensitization protocols (more vs. less fractioned) in terms of efficacy, while the incidence of rash and angioedema were higher in those protocols using less than 6 doses escalation.
During follow up, 65% of physicians managed aspirin hypersensitivity by changing the therapeutic regimen (e.g. Clopidogrel as monotherapy).
Despite prior safety data, desensitization protocols were used only by 42% of cardiologists.
Conclusion
The existing protocols to treat aspirin hypersensitivity are safe and effective and represent a viable option for patients that need dual antiaggregation therapy and are allergic to aspirin.
Editorial Comment
One of the desensitization protocols is the oral administration of 6 escalating doses of aspirin (1, 5, 10, 20, 40 and 100 mg) in 5.5 hours with or without simultaneous administration of corticoids and antihistamines. According to this study, consecutive doses should not be less than 6, because of the higher chance of angioedema and rash.
