title: Use of prasugrel in the setting of clopidogrel hypersensitivity: Case report and systematic review of the literature.
abstract: Allergic reactions to clopidogrel soon after coronary stent implantation pose an important and challenging clinical problem. We describe a 44-year-old man who developed a diffuse maculopapular rash four days after initiation of clopidogrel with drug-eluting coronary stent placement. An initial treat-through strategy was unsuccessful due to patient intolerance to corticosteroids. Because of persistent hypersensitivity, clopidogrel was substituted with prasugrel which was continued successfully for one year without reaction. A systematic review of the literature was performed which identified 10 prior case reports of patients with clopidogrel hypersensitivity who were subsequently treated with prasugrel. Patient characteristics and clinical outcomes of these patients plus the current case were reviewed. There were 9 men and 2 women with ages from 44 to 76 years. All patients had undergone coronary stent procedures. Prasugrel was successfully used without cross-reactivity in 9 of the 11 patients (82%). Cross-reactivity was reported in two patients who developed hypersensitivity reactions to prasugrel similar to those experienced on clopidogrel. In conclusion, prasugrel can be used successfully in most patients with a history of clopidogrel hypersensitivity. However, potential cross-reactivity between these two thienopyridines may occur in some patients.
authors: a Division of Cardiology, Department of Medicine , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors: Henry
authors: H
authors: Siu
authors: a Division of Cardiology, Department of Medicine , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors: Antony
authors: A
authors: Kaliyadan
authors: a Division of Cardiology, Department of Medicine , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors: David L
authors: DL
authors: Fischman
authors: a Division of Cardiology, Department of Medicine , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors: Evan
authors: E
authors: Nardone
authors: a Division of Cardiology, Department of Medicine , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors: David
authors: D
authors: Poll
authors: a Division of Cardiology, Department of Medicine , Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors: Michael P
authors: MP
authors: Savage
mesh_terms: D000328:Adult; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D057915:Drug Substitution; D054855:Drug-Eluting Stents; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: Antiplatelet drugs; clopidogrel; hypersensitivity; prasugrel; thienopyridine