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Clopidogrel desensitization after drug-eluting stent placement.

Abstract：

OBJECTIVES:We hypothesized that a standardized outpatient clopidogrel desensitization protocol would be safe and effective. BACKGROUND:Adverse reactions to clopidogrel are not uncommon, and affected patients must switch to ticlopidine after drug-eluting stent placement, despite its more malignant side-effect profile, because of the risk of ischemic events associated with premature discontinuation of dual antiplatelet therapy. METHODS:Patients with suspected clopidogrel sensitivity were treated with escalating doses of clopidogrel administered orally in solution until either a clinically significant reaction occurred or the full 75-mg tablet of clopidogrel was tolerated. Desensitization was performed on an outpatient basis except in cases in which the subjects were inpatients at the time of enrollment. Follow-up was performed at 2 to 4 weeks and 6 months after treatment. Successful desensitization was defined as the ability to take clopidogrel 75 mg daily without a mucocutaneous, bronchial, or anaphylactic response. RESULTS:We enrolled 24 consecutive patients with suspected reactions to clopidogrel after DES implantation, 20 of whom were outpatients. During desensitization, allergic-type reactions occurred in 4 patients and angina occurred in 1 patient. Desensitization was acutely successful in all 24 patients, and by 6-month follow-up, 1 patient had persistent but improved pruritus controlled with oral antihistamines and 23 remained asymptomatic, with only 2 patients requiring repeat desensitization. CONCLUSIONS:Clopidogrel desensitization is safe and effective, induces a sustained remission, and could be advantageous in treating outpatients who are at-risk for premature discontinuation of dual antiplatelet therapy.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

von Tiehl KF,Price MJ,Valencia R,Ludington KJ,Teirstein PS,Simon RA

doi

10.1016/j.jacc.2007.08.016

subject

Has Abstract

pub_date

2007-11-20 00:00:00

pages

2039-43

issue

21

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(07)02712-X

journal_volume

50

pub_type

临床试验,杂志文章

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