title: Early aspirin desensitization in unstable patients with acute coronary syndrome: Short and long-term efficacy and safety.
abstract: BACKGROUND
  Aspirin hypersensitivity is not a rare condition among patients with acute coronary syndrome. However, despite the publication of several successful desensitization protocols, the procedure is not as widespread as expected. We present a cohort of patients with acute coronary syndrome undergoing aspirin desensitization to evaluate its short- and long-term efficacy and safety and to reinforce data from previous studies.
  
  
  METHODS
  Of 1306 patients admitted to our Coronary Care Unit between February 2011 and February 2013, 24 (1.8%) had a history of aspirin hypersensitivity. All 24 patients underwent an eight-dose aspirin desensitization protocol (0.1, 0.3, 1, 3, 10, 25, 50 and 100 mg of aspirin given by mouth every 15 minutes) after premedication with antihistamines and corticosteroids or antileucotrienes. Previously prescribed β blockers and angiotensin-converting enzyme inhibitors were not discontinued. All patients were desensitized within 72 hours of admission. Those requiring urgent catheterization (five patients with ST segment elevation myocardial infarction) were desensitized within 12 hours of catheterization and the remainder before catheterization.
  
  
  RESULTS
  All patients were successfully desensitized and only one presented with an urticarial reaction. The five patients with ST segment elevation myocardial infarction were treated with abciximab until desensitization was complete. All but one patient underwent catheterization and 20 underwent percutaneous coronary intervention, most (66%) with the implantation of a bare metal stent. At follow-up (a minimum of 6-24 months), only two patients had discontinued aspirin, both due to gastrointestinal bleeding, and no hypersensitivy reaction had occurred.
  
  
  CONCLUSIONS
  Aspirin desensitization is effective and safe in unstable patients with acute coronary syndrome in both the short and long term.
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Juan Gabriel
authors.initials: JG
authors.lastname: Córdoba-Soriano
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Corbí-Pascual
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: López-Neyra
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Navarro-Cuartero
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Hidalgo-Olivares
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Barrionuevo-Sánchez
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Prieto-Mateos
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez-Díez
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Gallardo-López
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Fuentes-Manso
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Gómez-Pérez
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lafuente-Gormaz
authors.affiliation: Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Jiménez-Mazuecos
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects*; D006328:Cardiac Catheterization; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004342:Drug Hypersensitivity / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001241:Aspirin
keywords: Aspirin allergy; acute coronary syndrome; aspirin desensitization; coronary stenting; ischaemic heart disease