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Grimaldi S, Migliorini P, Puxeddu I, Rossini R, De Caterina R. Aspirin hypersensitivity: a practical guide for cardiologists. Eur Heart J 2024; 45:1716-1726. [PMID: 38666370 DOI: 10.1093/eurheartj/ehae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 05/22/2024] Open
Abstract
Aspirin has been known for a long time and currently stays as a cornerstone of antithrombotic therapy in cardiovascular disease. In patients with either acute or chronic coronary syndromes undergoing percutaneous coronary intervention aspirin is mandatory in a dual antiplatelet therapy regimen for prevention of stent thrombosis and/or new ischaemic events. Aspirin is also currently a first-option antithrombotic therapy after an aortic prosthetic valve replacement and is occasionally required in addition to oral anticoagulants after implantation of a mechanical valve. Presumed or demonstrated aspirin hypersensitivity is a main clinical problem, limiting the use of a life-saving medication. In the general population, aspirin hypersensitivity has a prevalence of 0.6%-2.5% and has a plethora of clinical presentations, ranging from aspirin-exacerbated respiratory disease to anaphylaxis. Although infrequent, when encountered in clinical practice aspirin hypersensitivity poses for cardiologists a clinical dilemma, which should never be trivialized, avoiding-as much as possible-omission of the drug. We here review the epidemiology of aspirin hypersensitivity, provide an outline of pathophysiological mechanisms and clinical presentations, and review management options, starting from a characterization of true aspirin allergy-in contrast to intolerance-to suggestion of desensitization protocols.
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Affiliation(s)
- Silvia Grimaldi
- Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Paola Migliorini
- Postgraduate School of Clinical Immunology, University of Pisa, Pisa, Italy
| | - Ilaria Puxeddu
- Postgraduate School of Clinical Immunology, University of Pisa, Pisa, Italy
| | - Roberta Rossini
- Cardiology Division, S. Croce e Carle Hospital, Cuneo, Italy
| | - Raffaele De Caterina
- Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
- Fondazione VillaSerena per la Ricerca, Viale L. Petruzzi 42, 65013 Città S. Angelo, Pescara, Italy
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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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Krasińska B, Paluszkiewicz L, Miciak-Lawicka E, Krasiński M, Rzymski P, Tykarski A, Krasiński Z. The effect of acetylsalicylic acid dosed at bedtime on the anti-aggregation effect in patients with coronary heart disease and arterial hypertension: A randomized, controlled trial. Cardiol J 2018; 26:727-735. [PMID: 30484269 DOI: 10.5603/cj.a2018.0142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acetylsalicylic acid (ASA) is one of the basic drugs used in the secondary prevention of coronary artery disease (CAD), and in most cases it is taken in the morning in one daily dose. It is suggested that the morning peak of platelet aggregation is responsible for the occurrence of myocardial infarctions and strokes. Hence, the aim of the study was to observe the effect of ASA (morning vs. evening) dosing on the anti-aggregative effect of platelets in patients with CAD and arterial hypertension (AH). METHODS The study involved 175 patients with CAD and AH. Patients were randomly assigned to one of two study groups, taking ASA in the morning or in the evening. The patients had two visits, one baseline and another after 3 months from changing the time of ASA dosage. The platelet aggregation was determined using the VerifyNow analyzer. RESULTS In the ASA evening group, a significant reduction in platelet aggregation was obtained. In the ASA morning group, a significant difference in response to ASA was observed, depending on sex. In men, the reactivity of platelets decreased, but in women it increased. CONCLUSIONS In the group of patients with CAD and AH, bedtime ASA dosing is associated with a significant reduction in platelet aggregation. The response to ASA may differ between sexes. The benefit gained by changing the drug administration from the morning to the evening is greater in women.
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Affiliation(s)
- Beata Krasińska
- Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland.
| | - Lech Paluszkiewicz
- Department of Thoracic And Cardiovascular Surgery/Perioperative diagnostics Bad Oeynhausen, Heart and Diabetes Center NRW, Ruhr-University of Bochum, Germany
| | - Ewa Miciak-Lawicka
- Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Krasiński
- Student, Imperial College London School of Medicine, United Kingdom
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Tykarski
- Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Zbigniew Krasiński
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Díez-Villanueva P, Antuña P, Múgica M, Belver M, Aguilar R, Alfonso F. Desensibilización a la aspirina en pacientes con síndrome coronario agudo. Med Intensiva 2016; 40:452-4. [DOI: 10.1016/j.medin.2015.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/19/2015] [Accepted: 12/24/2015] [Indexed: 11/15/2022]
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Córdoba-Soriano JG, Corbí-Pascual M, López-Neyra I, Navarro-Cuartero J, Hidalgo-Olivares V, Barrionuevo-Sánchez MI, Prieto-Mateos D, Gutiérrez-Díez A, Gallardo-López A, Fuentes-Manso R, Gómez-Pérez A, Lafuente-Gormaz C, Jiménez-Mazuecos J. Early aspirin desensitization in unstable patients with acute coronary syndrome: Short and long-term efficacy and safety. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:41-50. [DOI: 10.1177/2048872615618509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Miguel Corbí-Pascual
- Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain
| | - Isabel López-Neyra
- Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain
| | | | | | | | - Daniel Prieto-Mateos
- Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain
| | | | | | - Raquel Fuentes-Manso
- Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain
| | - Alberto Gómez-Pérez
- Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain
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Acetylsalicylic acid desensitization in patients with coronary artery disease: A comprehensive overview of currently available protocols. Vascul Pharmacol 2016; 80:43-9. [DOI: 10.1016/j.vph.2015.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/08/2015] [Accepted: 09/23/2015] [Indexed: 12/29/2022]
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Giavina-Bianchi P, Aun MV, Galvão VR, Castells M. Rapid Desensitization in Immediate Hypersensitivity Reaction to Drugs. CURRENT TREATMENT OPTIONS IN ALLERGY 2015. [DOI: 10.1007/s40521-015-0060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Desensibilización al ácido acetilsalicílico en pacientes sometidos a intervencionismo coronario percutáneo. Experiencia en un centro terciario. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Díez-Villanueva P, Pineda R, Sánchez PL, Tornero P, Fernández-Avilés F. Desensitization to acetylsalicylic acid in patients undergoing percutaneous coronary intervention. Experience in a tertiary center. ACTA ACUST UNITED AC 2014; 67:494-6. [PMID: 24863603 DOI: 10.1016/j.rec.2014.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Rafael Pineda
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro L Sánchez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Tornero
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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