A novel strategy for managing clopidogrel-induced adverse skin reactions.
OBJECTIVE
We conducted a prospective observational study using a course of steroids and antihistamines to treat a cohort of patients who developed skin reactions to clopidogrel, to assess whether dual antiplatelet therapy could be continued in an outpatient setting.


RESULTS
This study included 2,701 patients who underwent percutaneous coronary intervention (PCI) at our centre over a 23 month period. Patients with skin reactions to clopidogrel were identified and then commenced on five days oral prednisolone (30 mg/od) and chlorpheniramine (4 mg/tds) for seven days. A subsequent telephone survey was performed to evaluate a number of variables. The probability of the adverse reaction being secondary to clopidogrel was assessed using the Naranjo adverse drug reaction probability scale. Twenty (0.7%) patients were identified who developed adverse skin reactions to clopidogrel. There was complete resolution seen in the majority (89%) of patients within an average of 3.2 days following treatment. One patient had partial resolution, and one had no response to treatment, but both were able to continue clopidogrel.


CONCLUSIONS
We propose a novel, safe and effective way of managing clopidogrel-induced skin reactions using a short course of prednisolone and chlorpheniramine, without stopping or substituting clopidogrel.
McKenzie
Daniel B
DB
Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, East Dorset, UK. dan.mckenzie@rbch.nhs.uk
Rao
Usha
U
Hobson
Alex
A
Levy
Terry
T
Talwar
Suneel
S
Swallow
Rosie
R
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002744:Chlorpheniramine / Q000627:therapeutic use; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011239:Prednisolone / Q000627:therapeutic use; D011336:Probability; D012871:Skin Diseases / Q000139:chemically induced* / Q000188:drug therapy; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D010975:Platelet Aggregation Inhibitors; D002744:Chlorpheniramine; D011239:Prednisolone; D000077144:Clopidogrel; D013988:Ticlopidine