title: Aspirin desensitization in patients undergoing planned or urgent coronary stent implantation. A single-center experience.
abstract: BACKGROUND
  Dual antiplatelet therapy (aspirin and ADP-antagonists) is mandatory after stent implantation in order to avoid stent thrombosis, especially in the era of DES. In fact, a delayed re-endothelization process may enlarge the window of occurrence of stent thrombosis beyond 1-year after implantation. Allergy to acid acetylsalicylic is not a rare event and may influence the use and the choice of coronary stent with an important impact in terms of outcome especially in patients at high risk for in-stent restenosis. The aim of this study was to evaluate the safety and efficacy of a new intravenous rapid desensitization protocol in patients with acetylsalicylic acid sensitivity undergoing coronary stent implantation.
  
  
  METHODS
  Among a total of 1385 patients undergoing coronary angioplasty at our catheterization laboratory from January 2007 to June 2011, a total of 43 patients (3.1%) had history of aspirin sensitivity characterized by respiratory or cutaneous manifestations (none had previous anaphylactic reactions). Twenty-three patients (53.5%) presented with acute coronary syndromes. All patients underwent a novel rapid desensitization procedure before or after cardiac catheterization (in case of ST-elevation myocardial infarctions, n=5). The desensitization procedure was based on intravenous administration of 9 sequential doses of aspirin (1, 2, 4, 8, 16, 32, 64, 128, 250 mg) over 4.5h without the use of corticosteroids or antihistamines. Patients were followed for at least 30 days and up to 12 months to assess compliance with aspirin therapy and adverse events.
  
  
  RESULTS
  The desensitization procedure was successful in 42 patients (97.6%). All patients underwent stent implantation (1.6 stents/patient). Drug-eluting stents were used in 36 patients (85.7%). At follow-up, all patients who successfully responded to the desensitization procedure did not develop any allergic reaction.
  
  
  CONCLUSIONS
  This study showed the safety and efficacy of a new rapid intravenous protocol desensitization for patients with history of aspirin sensitivity undergoing planned or urgent coronary stent implantation.
authors.affiliation: Division of Cardiology, Ospedale Maggiore della Carità, Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Monica
authors.initials: M
authors.lastname: Verdoia
authors.forename: Giulia
authors.initials: G
authors.lastname: Binda
authors.forename: Alon
authors.initials: A
authors.lastname: Schaffer
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000453:epidemiology / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D001241:Aspirin