Meta-Analysis of Acetylsalicylic Acid Desensitization in Patients With Acute Coronary Syndrome

Affiliations


Abstract

Acetylsalicylic acid (ASA) hypersensitivity represents a clinical challenge in acute coronary syndrome (ACS) patients urgently requiring ASA for antiplatelet therapy. ASA desensitization has been reported with successful outcomes in cardiac patients. The aim of this review is to determine the safety and efficacy of ASA desensitization therapy in ACS patients. A PubMed database search was conducted for articles containing combinations of keywords, "aspirin desensitization" or "aspirin hypersensitivity" and "acute coronary syndrome" between January 1, 1990 and August 1, 2018. The primary end point was desensitization protocol success. Secondary end points included hypersensitivity adverse events and ASA discontinuation due to hypersensitivity adverse events at follow-up. Fifteen reports consisting of 480 ACS patients with previous hypersensitivity to ASA were included. The pooled desensitization success rate was 98.3% (95% confidence interval: 97.2% to 99.5%). There was no statistical difference in outcomes between protocols ≤ 2 hours and > 2 hours in duration (96.3[92.3 to 100.3]% vs 97.2[94.6 to 99.8]%; p = 0.71). Protocols with > 6 dose escalations were associated with higher success rates compared to those with ≤ 6 doses (99.2[97.9 to 100.4]% vs 95.4[93 to 97.8]%; p = 0.007). At follow-up between 1 and 46 months (mode 12 months), zero hypersensitivity adverse events were reported. Consequently, no ASA discontinuations were related to hypersensitivity adverse events. In conclusion, ASA desensitization therapy is safe and effective in patients with ACS. Protocols with > 6 dose escalations may be optimal for ASA desensitization in ACS patients.


Similar articles

Acetylsalicylic acid challenge or desensitization in sensitive patients with cardiovascular disease.

Cortellini G, Raiteri A, Galli M, Lotrionte M, Piscaglia F, Romano A.J Thromb Thrombolysis. 2023 May;55(4):762-769. doi: 10.1007/s11239-023-02782-1. Epub 2023 Feb 9.PMID: 36757645

Acetylsalicylic acid desensitization in patients with coronary artery disease: A comprehensive overview of currently available protocols.

Verdoia M, Barbieri L, Schaffer A, Nardin M, Suryapranata H, De Luca G.Vascul Pharmacol. 2016 May;80:43-9. doi: 10.1016/j.vph.2015.09.005. Epub 2015 Oct 9.PMID: 26456910 Review.

[Acetylsalicylic acid desensitization in the new era of percutaneous coronary intervention].

Fuertes Ferre G, Ferrer Gracia MC, Calvo Cebollero I.Med Clin (Barc). 2015 Sep 21;145(6):253-7. doi: 10.1016/j.medcli.2014.10.014. Epub 2015 Jan 8.PMID: 25577589 Review. Spanish.

Aspirin Desensitization in Patients With Coronary Artery Disease: Results of the Multicenter ADAPTED Registry (Aspirin Desensitization in Patients With Coronary Artery Disease).

Rossini R, Iorio A, Pozzi R, Bianco M, Musumeci G, Leonardi S, Lettieri C, Bossi I, Colombo P, Rigattieri S, Dossena C, Anzuini A, Capodanno D, Senni M, Angiolillo DJ.Circ Cardiovasc Interv. 2017 Feb;10(2):e004368. doi: 10.1161/CIRCINTERVENTIONS.116.004368.PMID: 28193678

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement.

Al-Ahmad M, Rodriguez-Bouza T, Nurkic M.Int Arch Allergy Immunol. 2018;175(4):237-245. doi: 10.1159/000486415. Epub 2018 Jan 26.PMID: 29393216 Clinical Trial.


Cited by

Acetylsalicylic acid challenge or desensitization in sensitive patients with cardiovascular disease.

Cortellini G, Raiteri A, Galli M, Lotrionte M, Piscaglia F, Romano A.J Thromb Thrombolysis. 2023 May;55(4):762-769. doi: 10.1007/s11239-023-02782-1. Epub 2023 Feb 9.PMID: 36757645

Recent Updates in Understanding NSAID Hypersensitivity.

Minaldi E, Cahill K.Curr Allergy Asthma Rep. 2023 Mar;23(3):181-188. doi: 10.1007/s11882-023-01064-3. Epub 2023 Feb 9.PMID: 36757490 Review.

Patient characterization and predictors of aspirin desensitization response.

Cheong Z, Tan CYL, Lim CP, Soong JL, Chong CJM, Chan AKW.Asia Pac Allergy. 2021 Apr 27;11(2):e20. doi: 10.5415/apallergy.2021.11.e20. eCollection 2021 Apr.PMID: 34007830 Free PMC article.


KMEL References