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Current Vascular Pharmacology

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ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

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Review Article

Managing Clopidogrel Hypersensitivity without Interrupting Therapy: The Toronto Approach

Author(s): Asim N. Cheema*

Volume 17, Issue 2, 2019

Page: [119 - 122] Pages: 4

DOI: 10.2174/1389200219666180820114435

Price: $65

Abstract

Clopidogrel remains a widely used antiplatelet agent for patients with established or high risk of atherothrombotic disease, particularly those treated with coronary, carotid or peripheral endovascular stenting. Clopidogrel hypersensitivity is an uncommon but well established adverse drug reaction presenting a challenge for patient management. The clinical presentation ranges from focal or diffuse cutaneous manifestations in most patients to angioedema in some and a systemic immune response in rare cases. The treatment options include drug discontinuation with or without desensitization therapy, switching to alternate ADP receptor antagonists or administration of oral steroids while continuing clopidogrel in patients at high risk of adverse events with clopidogrel discontinuation. In this review the author describes the phenomenon of clopidogrel hypersensitivity, various treatment strategies.

Keywords: Clopidogrel, hypersensitivity, ADP receptor antagonist, drug allergy, adverse drug reaction, skin rash.

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[1]
Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502.
[2]
Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005; 352: 1179-89.
[3]
CAPRIE steering committee. A randomised, blinded, trial of Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE). Lancet 1996; 348: 1329-39.
[4]
Allemang MT, Rajani RR, Nelson PR, Hingorani A, Kashyap VS. Prescribing patterns of antiplatelet agents are highly variable after lower extremity endovascular procedures. Ann Vasc Surg 2013; 27: 62-7.
[5]
Gortler D, Schlosser FJ, Muhs BE, Nelson MA, Dardik A. Periprocedural drug therapy in carotid artery stenting: The need for more evidence. Vascular 2008; 16: 303-9.
[6]
Grines CL, Bonow RO, Casey DE Jr, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: A science advisory from the American heart association, American college of cardiology, society for cardiovascular angiography and interventions, American college of surgeons, and American dental association, with representation from the American college of physicians. Circulation 2007; 115: 813-8.
[7]
Cheema AN, Mohammad A, Hong T, et al. Characterization of clopidogrel hypersensitivity reactions and management with oral steroids without clopidogrel discontinuation. J Am Coll Cardiol 2011; 58: 1445-54.
[8]
Chin CT, Boden WE, Roe MT, et al. Effect of prior clopidogrel use on outcomes in medically managed acute coronary syndrome patients. Heart 2016; 102: 1221-9.
[9]
Bagai A, Wang TY, Goodman SG, et al. Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian observational anti-platelet study. Int J Cardiol 2017; 228: 459-64.
[10]
Sheikh Rezaei S, Geroldinger A, Heinze G, Reichardt B, Wolzt M. Clopidogrel, prasugrel, or ticagrelor use and clinical outcome in patients with acute coronary syndrome: A nationwide long-term registry analysis from 2009 to 2014. Int J Cardiol 2017; 235: 61-6.
[11]
Alexopoulos D, Xanthopoulou I, Deftereos S, et al. Contraindications/special warnings and precautions for use of contemporary oral antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Circ J 2014; 78: 180-7.
[12]
Beigel R, Iakobishvili Z, Shlomo N, et al. Real-world use of novel p2y12 inhibitors in patients with acute myocardial infarction: A treatment paradox. Cardiology 2017; 136: 21-8.
[13]
Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361: 1045-57.
[14]
Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357: 2001-15.
[15]
Fosbol EL, Ju C, Anstrom KJ, et al. Early cessation of adenosine diphosphate receptor inhibitors among acute myocardial infarction patients treated with percutaneous coronary intervention: insights from the translate-ACS study (Treatment with adenosine diphosphate receptor inhibitors: Longitudinal assessment of treatment patterns and events after acute coronary syndrome). Circ Cardiovasc Interv 2016; 9.
[16]
Zettler ME, Peterson ED, McCoy LA, et al. Switching of adenosine diphosphate receptor inhibitor after hospital discharge among myocardial infarction patients: Insights from the treatment with adenosine diphosphate receptor inhibitors: Longitudinal assessment of treatment patterns and events after acute coronary syndrome (TRANSLATE-ACS) observational study. Am Heart J 2017; 183: 62-8.
[17]
Lokhandwala JO, Best PJ, Butterfield JH, et al. Frequency of allergic or hematologic adverse reactions to ticlopidine among patients with allergic or hematologic adverse reactions to clopidogrel. Circ Cardiovasc Interv 2009; 2: 348-51.
[18]
Steinhubl SR, Tan WA, Foody JM, Topol EJ. Incidence and clinical course of thrombotic thrombocytopenic purpura due to ticlopidine following coronary stenting. EPISTENT Investigators. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. JAMA 1999; 281: 806-10.
[19]
Walker NE, Fasano MB, Horwitz PA. Desensitization for the management of clopidogrel hypersensitivity: Initial clinical experience. J Invasive Cardiol 2006; 18: 341-4.
[20]
von Tiehl KF, Price MJ, Valencia R, et al. Clopidogrel desensitization after drug-eluting stent placement. J Am Coll Cardiol 2007; 50: 2039-43.
[21]
Camara MG, Almeda FQ. Clopidogrel (Plavix) desensitization protocol. Catheter Cardiovasc Interv 2007; 69: 154.
[22]
Fajt M, Petrov A. Clopidogrel hypersensitivity: A novel multi-day outpatient oral desensitization regimen. Ann Pharmacother 2010; 44: 11-8.
[23]
Fernando SL, Assaad NN. Rapid and sequential desensitization to both aspirin and clopidogrel. Intern Med J 2010; 40: 596-9.

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