Aspirin desensitization in patients undergoing planned or urgent coronary stent implantation. A single-center experience

Introduction: 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 impor- tant 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 pa- tients (53.5%) presented with acute coronary syndromes. All patients underwent a novel rapid desensitiza- tion 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 aspi- rin (1, 2, 4, 8, 16, 32, 64, 128, 250 mg) over 4.5 h 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 ad- verse events. Results: The desensitization procedure was successful in 42 patients (97.6%). All patients underwent stent im- plantation (1.6 stents/patient). Drug-eluting stents were used in 36 patients (85.7%). At follow-up, all pa- tients 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.