Aspirin Desensitization in Patients with Coronary Artery Disease

There are limited data on aspirin desensitization in patients with coronary artery disease (CAD). The aim of this study was to test the safety and efficacy of a rapid desensitization protocol inpatients with a history of aspirin sensitivity about to receive PCI.

This was a prospective multicenter observational study, carried out in seven Italian centers including patients with a history of aspirin hypersensitivity in the context of a coronary angiogram and eventual PCI.

The study included an overall of 330 patients in said conditions with a history of CAD, suspected as a stable condition, and also patients undergoing ST elevation acute myocardial infarction.

Prior aspirin adverse events included:

• urticaria (n=177, 53.6%),
• angioedema (n=69, 20.9%),
• asthma (n=65, 19.7%),
• anaphylactic reaction (n=19, 5.8%).

Among those presenting urticaria/angioedema, 13 also has a history of chronic idiopathic urticaria.

The desensitization procedure was done before catheterization, with the exception of patients undergoing ST elevation AMI (n=78, 23.6%), who underwent the procedure after catheterization. In these last patients, the use of IIb/IIIa glycoprotein inhibitors was left to the operator’s criteria.

Desensitization involved the oral administration of six sequential doses of aspirin (1, 5, 10, 20, 40 y 100 mg) during 5.5 hours. Aspirin administration was immediately interrupted whenever there were systemic, respiratory or mucocutaneoussigns of hypersensitivity. After desensitization, patients continued to take 100 mg aspirin per day. In all elective cases, the use of corticoids, antihistamine or anti leukotrienes was interrupted seven days after desensitization.

Of all patients, 71% (n=235) finally required PCI. The desensitization protocol was successful in 315 patients (95.4%) and all those with a history of anaphylactic reaction.

The 15 patients (4.6%) that did not respond to treatment only presented minor adverse reactions that were well managed with corticosteroids and antihistamines.

80% continued with aspirin for at least 12 months and those who decided to discontinue treatment did so because of medical decision, not because of adverse events.

Conclusion

Rapid desensitization protocol resulted safe and effective in a wide range of patients regardless the type of reaction to aspirin they used to have.

Original Title: Aspirin Desensitization in Patients with Coronary Artery Disease. Results of the Multicenter ADAPTED Registry (Aspirin Desensitization in Patients with Coronary Artery Disease).

Reference: Roberta Rossini et al. CircCardiovascInterv. 2017 Feb;10(2).

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.