Clopidogrel desensitization after drug-eluting stent placement.

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
• 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 [Electronic] United States
• PMID: 18021870 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine

Topics

• Clopidogrel
• 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