Aspirin Desensitization in Patients With Coronary Artery Disease

MedicalResearch.com Interview with:

Roberta Rossini, MD, PhD USC Cardiologia, Cardiovascular Department Bergamo, Italy

Dr. Rossini

Dr. Roberta Rossini, MD, PhD
USC Cardiologia, Cardiovascular Department
Bergamo, Italy 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Aspirin (ASA) is stilll the cornerstone of antithrombotic therapy in patients with coronary artery disease, especially after PCI, both

in the acute and the chronic phase of treatment. However, ≈2% of patients have hypersensitivity to ASA. ASA desensitization may represent a valid approach. Desensitization protocols generally involve gradual increases in patient exposure to ASA with the goal of mitigating or abolishing immune-mediated reaction. However, many desensitization protocols require several days to be completed, making them unpractical. This may also contribute to the limited experience with applying ASA desensitization protocols in real-world practice in patients with CAD.

We previously reported the results of a pilot investigation supporting the feasibility of performing a rapid (<6 hours)

Aspirin desensitization protocol in patients undergoing PCI with stent implantation (Rossini R, Angiolillo DJ, Musumeci G, Scuri P, Invernizzi P, Bass TA, Mihalcsik L, Gavazzi A. Aspirin desensitization in patients undergoing percutaneous coronary interventions with stent implantation. Am J Cardiol. 2008;101:786–789. doi: 10.1016/j.amjcard.2007.10.045). The encouraging findings from our pilot feasibility investigation prompted the design of a larger scale multicenter investigation aimed to assess the safety and efficacy of a rapid aspirin  desensitization protocol in patients with a history of ASA hypersensitivity undergoing coronary angiography.

MedicalResearch.com: What should readers take away from your report?

Response: The main finding of this study is that a rapid standardized desensitization protocol in patients with aspirin hypersensitivity undergoing coronary angiography is safe and effective, irrespective of the type of sensitivity, including in patients with ACS.

Low-dose ASA can be safely continued long term without the occurrence of late adverse hypersensitivity events.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The main limitation of the present registry is related to the definition of aspirin hypersensitivity, which was self-reported and diagnosed only on history data and was not confirmed by specific tests. However, the desensitization procedure allows administering ASA to patients who otherwise may not be treated with ASA. Second, in patients who failed the desensitization protocol, a new attempt to desensitize was not performed.

Indeed, the use of smaller increments of aspirin doses could have potentially enhanced our success rate. Further studies may address whether a new attempt with smaller doses might be successful in patients in whom this protocol has failed. Finally, although this registry is larger than other reports of aspirin desensitization, the sample size is still limited, particularly for patients with a history of anaphylaxis.

Therefore, larger studies are warranted to confirm the safety of our desensitization protocol in these patients. 

Disclosures: I received payment as an individual for consulting fee or honorarium from Eli Lilly and Co, Daiichi Sankyo, Inc, and Astra Zeneca. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Circ Cardiovasc Interv. 2017 Feb;10(2). pii: e004368. doi: 10.1161/CIRCINTERVENTIONS.116.004368.

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

Rossini R1, Iorio A2, Pozzi R2, Bianco M2, Musumeci G2, Leonardi S2, Lettieri C2, Bossi I2, Colombo P2, Rigattieri S2, Dossena C2, Anzuini A2, Capodanno D2, Senni M2, Angiolillo DJ2.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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