NEW YORK (Reuters Health) – Suppressive therapy with corticosteroids and antihistamines is effective for managing clopidogrel hypersensitivity in the majority of cases, allowing antiplatelet therapy to continue uninterrupted, a small study indicates.
Dr. Michael P. Savage and colleagues at Jefferson Medical College, Philadelphia, Pennsylvania point out in their report in the American Journal of Cardiology online January 20 that up to 6% of percutaneous coronary intervention patients treated with clopidogrel develop a hypersensitivity reaction in the first week or two of treatment. Discontinuing clopidogrel during this period, however, is a major risk factor for stent thrombosis.
The researchers therefore assessed a strategy for treating hypersensitivity symptoms while continuing clopidogrel. “The rationale of this strategy was to enable the development of physiologic tolerance without interrupting therapy, thus decreasing the risk for adverse cardiac events” they explain.
The study involved 25 consecutive patients who developed clopidogrel hypersensitivity an average of 6 days after undergoing PCI. Corticosteroids alone were used to treat 5 patients, antihistamines alone in another 5 patients, while 15 patients were treated with both corticosteroids and antihistamines.
“Treatment was successful with sustained symptom resolution in 22 of 25 patients (88%),” the investigators found.
In successfully desensitized patients, clopidogrel therapy was then continued for a mean of 417 days, and in all cases exceeded the minimum target duration recommended in guidelines by the American College of Cardiology and American Heart Association.
“Although the optimal treatment regimen remains to be established,” Dr. Savage and colleagues conclude, “this study demonstrates that patients with clopidogrel hypersensitivity can continue the drug uninterrupted as they develop physiologic tolerance facilitated by antiallergy therapy.”
Reference:
Management of Clopidogrel Hypersensitivity Without Drug Interruption
Am J Cardiol 2011.
