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1
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Verdoia M, Gioscia R, Nardin M, De Luca G. ASA Allergy and Desensitization Protocols in the Management of CAD: A Review of Literature. J Clin Med 2023; 12:5627. [PMID: 37685694 PMCID: PMC10488748 DOI: 10.3390/jcm12175627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Acetylsalicylic acid (ASA) hypersensitivity still represents one of the major deals for patients with atherosclerotic cardiovascular disease (ASHD), especially for those requiring percutaneous coronary interventions in the absence of validated alternative options. Despite symptoms after ASA administration being reported in 6-20% of cases, true ASA allergy only represents a minority of the patients, pointing to the importance of challenge tests and potential strategies for tolerance induction. ASA desensitization protocols were proposed several decades ago, with accumulating the literature on their use in patients undergoing PCI either for chronic disease or acute coronary syndromes. Nevertheless, the promising results of the studies and meta-analyses have not been validated so far by the support of large-scale randomized trials or unique indications from guidelines. Therefore, ASA desensitization is still largely unapplied, leaving the management of ASA hypersensitivity to the individualized approach of cardiologists.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Nuovo Ospedale degli Infermi, ASL Biella, 13900 Biella, Italy;
| | - Rocco Gioscia
- Division of Cardiology, Nuovo Ospedale degli Infermi, ASL Biella, 13900 Biella, Italy;
| | - Matteo Nardin
- Division of Internal Medicine, Spedali Civili, 13900 Brescia, Italy;
| | - Giuseppe De Luca
- Divisione di Cardiologia, AOU “Policlinico G. Martino”, 98122 Messina, Italy;
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98122 Messina, Italy
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant’Ambrogio, 20151 Milan, Italy
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Thakker RA, Salazar L, Jazar DA, Bhakta P, Baker B, Patel C, Elbadawi A, Agarwal M, Albaeni A, Saleh M, Esclovan J, El Haddad D, Alwash H, Kalra A, Goel SS, Widmer RJ, Chatila K, Khalife W, Motiwala A, McCracken J, Jneid H, Gilani S. Coronary Artery Disease and Aspirin Intolerance: Background and Insights on Current Management. Cardiol Ther 2022; 11:175-183. [PMID: 35344187 PMCID: PMC9135937 DOI: 10.1007/s40119-022-00255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Indexed: 11/28/2022] Open
Abstract
Aspirin is one of the most widely used medications across the global healthcare system and is the foundation in treating ischemic heart disease, as well as secondary prevention for ischemic and valvular heart disease. Challenges arise in treating patients with cardiovascular disease who have concomitant aspirin intolerance. Through an extensive review of the literature, we provide a comprehensive background on the pharmacology of aspirin, the mechanisms behind aspirin intolerance, the importance of aspirin in cardiovascular disease, and the management of aspirin intolerance in both acute coronary syndrome and stable coronary artery disease. Our review includes a multidisciplinary approach from the internist, allergist/immunologist, and cardiologist when evaluating this important patient population.
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Affiliation(s)
- Ravi A Thakker
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA.
| | - Leonardo Salazar
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Deaa Abu Jazar
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Pooja Bhakta
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Bryan Baker
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Chandani Patel
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Ayman Elbadawi
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mayank Agarwal
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Aiham Albaeni
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohammed Saleh
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jonathan Esclovan
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Danielle El Haddad
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Hashim Alwash
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Robert Jay Widmer
- Division of Cardiology, Scott and White Heart Memorial Hospital, Baylor Scott and White Health, Temple, TX, USA
| | - Khaled Chatila
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Afaq Motiwala
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jennifer McCracken
- Division of Allergy and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Syed Gilani
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
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3
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Vlachos C, Alexis I, Moulias C, Rammos A, Lakkas L, Gavriil S, Michalis LK, Bassukas ID. A single center experience of rapid aspirin desensitization in acute coronary syndrome patients. Hellenic J Cardiol 2021; 64:99-100. [PMID: 34311102 DOI: 10.1016/j.hjc.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/12/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Christoforos Vlachos
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Alexis
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
| | - Christos Moulias
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
| | - Aidonis Rammos
- 2(nd) Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Lampros Lakkas
- 2(nd) Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Sofia Gavriil
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- 2(nd) Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece.
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