| Abstract | OBJECTIVES: We hypothesized that a standardized outpatient clopidogrel desensitization protocol would be safe and effective. BACKGROUND: Adverse reactions to clopidogrel are not uncommon, and affected patients must switch to ticlopidine after drug-eluting stent placement, despite its more malignant side-effect profile, because of the risk of ischemic events associated with premature discontinuation of dual antiplatelet therapy. METHODS: Patients with suspected clopidogrel sensitivity were treated with escalating doses of clopidogrel administered orally in solution until either a clinically significant reaction occurred or the full 75-mg tablet of clopidogrel was tolerated. Desensitization was performed on an outpatient basis except in cases in which the subjects were inpatients at the time of enrollment. Follow-up was performed at 2 to 4 weeks and 6 months after treatment. Successful desensitization was defined as the ability to take clopidogrel 75 mg daily without a mucocutaneous, bronchial, or anaphylactic response. RESULTS: We enrolled 24 consecutive patients with suspected reactions to clopidogrel after DES implantation, 20 of whom were outpatients. During desensitization, allergic-type reactions occurred in 4 patients and angina occurred in 1 patient. Desensitization was acutely successful in all 24 patients, and by 6-month follow-up, 1 patient had persistent but improved pruritus controlled with oral antihistamines and 23 remained asymptomatic, with only 2 patients requiring repeat desensitization. CONCLUSIONS: Clopidogrel desensitization is safe and effective, induces a sustained remission, and could be advantageous in treating outpatients who are at-risk for premature discontinuation of dual antiplatelet therapy. |
| Authors | Karl F von Tiehl, Matthew J Price, Rafael Valencia, Katherine J Ludington, Paul S Teirstein, Ronald A Simon
(Affiliation: Division of Allergy, Asthma & Immunology, Scripps Clinic and Scripps Green Hospital, La Jolla, California, USA. vontiehl.karl at scrippshealth.org)
|
| Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 50
Issue 21
Pg. 2039-43
(Nov 20 2007)
ISSN: 1558-3597 United States |
| PMID | 18021870
(Publication Type: Clinical Trial, Journal Article)
|
| Chemical References |
- Platelet Aggregation Inhibitors
- Ticlopidine
- clopidogrel
|
| Topics |
- Coronary Artery Disease
(therapy)
- Desensitization, Immunologic
- Drug Hypersensitivity
(drug therapy, etiology)
- Drug-Eluting Stents
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Platelet Aggregation Inhibitors
(administration & dosage, adverse effects)
- Ticlopidine
(administration & dosage, adverse effects, analogs & derivatives)
- Treatment Outcome
|
