title: Use of prasugrel in a patient with clopidogrel hypersensitivity.
abstract: OBJECTIVE
  To report a case of successful use of prasugrel following percutaneous coronary intervention with placement of a bare metal stent in a patient with a documented hypersensitivity reaction to clopidogrel.
  
  
  METHODS
  A 61-year-old male with a history of coronary artery disease with coronary stent placement presented with ST-elevation myocardial infarction. The patient had developed Stephens-Johnson syndrome 6 years earlier following clopidogrel administration, characterized by erythematous plaques and subsequent desquamation of the hands and feet; clopidogrel was discontinued and he was subsequently treated with ticlopidine in addition to aspirin. The third-generation thienopyridine prasugrel was initiated as a therapeutic alternative to clopidogrel after placement of a bare metal stent; a 60-mg dose was administered after extubation, followed by 10 mg/day. No signs of allergic reaction were observed in the days, weeks, and months following administration.
  
  
  CONCLUSIONS
  Thienopyridines, specifically clopidogrel, are the standard of care for prevention of coronary stent thrombosis; however, there are few data available on cross-hypersensitivity between these agents. One study demonstrated that 27% of patients who developed an allergic or hematologic reaction to clopidogrel developed a similar reaction to ticlopidine. Other therapeutic options for patients with clopidogrel hypersensitivity who are undergoing a percutaneous coronary intervention with stent placement include clopidogrel desensitization, warfarin plus aspirin, cilostazol, ticagrelor, and ticlopidine. However, these options are limited by efficacy and/or toxicity. With its approval in 2009, prasugrel has become a potential treatment option.
  
  
  CONCLUSIONS
  Prasugrel may be considered a therapeutic alternative in some patients allergic or intolerant to clopidogrel, but additional data are warranted to make a strong conclusion.
authors: Department of Pharmacy Practice, School of Pharmacy, Concordia University Wisconsin, Mequon, WI, USA. Sarah.Peppard@cuw.edu
authors: Sarah R
authors: SR
authors: Peppard
authors: Bethanne M
authors: BM
authors: Held-Godgluck
authors: Richard
authors: R
authors: Beddingfield
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000077144:Clopidogrel; D004342:Drug Hypersensitivity / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D010879:Piperazines / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects; D013876:Thiophenes / Q000627:therapeutic use*; D013927:Thrombosis / Q000517:prevention & control*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine