Aspirin challenge/desensitisation before coronary stenting in subjects with history of hypersensitivity. A pragmatic approach

G. Cortellini, S. Testi, M. Severino, T. Chechi, M.L. Iorno, A. Santucci, A. Corvetta, G. Piovaccari, A. Santarelli, N. Franco, GW. Canonica, G. Passalacqua

Background. Aspirin hypersensitivity may represent a major problem in patients with ischemic coronary disease who need a stenting procedure. In those patients, clinically unsettled, reasonably quick desensitisation procedures are needed. In our study we attempted to select the most suitable procedure on the basis of characteristics and severity of ASA hypersensitivity. MethodsThirty patients with a history of mild reactions to anti-inflammatory doses of aspirin (> 325 mg) were considered at low risk and underwent a tolerance test in 5 steps. Thirty-one patients,with a history of severe reactions to anti-platelet doses of aspirin (100 mg) underwent a slow desensitisation in 12 steps, reaching a cumulative dose of 150mg ASA in 220 minutes.Results. In the first group, 29 patients tolerated the challenge. One developed urticaria, thus underwent challenge/desensitisation and achieved tolerance. In the second group, 3 patients did not tolerate the procedure and had to discontinue. Conclusion. Our approach to aspirin hypersensitivity in patients needing coronary stenting, based on a severity stratification, allowed to achieve an effective tolerance to aspirin in the majority of subject in a reasonable short time.
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