Division of Cardiology, Jefferson Medical College, Philadelphia, PA, USA.
Am J Cardiol. 2011 Mar 15;107(6):812-6. doi: 10.1016/j.amjcard.2010.11.002. Epub 2011 Jan 19.
Clopidogrel hypersensitivity affects up to 6% of treated patients, often leading to discontinuation of the drug. Conventional desensitization protocols incorporate a washout period off medication that may be problematic after percutaneous coronary intervention because premature discontinuation of dual antiplatelet therapy is a major risk factor for stent thrombosis. The purpose of this study was to evaluate a strategy for treating clopidogrel hypersensitivity without drug interruption using corticosteroids and antihistamines to facilitate development of physiologic tolerance. The study population consisted of 25 consecutive patients who developed clopidogrel hypersensitivity after percutaneous coronary intervention and were managed with suppressive therapy using corticosteroids and antihistamines. Treatment success (resolution of hypersensitivity symptoms without interrupting clopidogrel) was assessed, in addition to duration of clopidogrel therapy and adverse cardiac events during late follow-up (mean 670 ± 630 days). The cohort included 19 men and 6 women with a mean age of 62 ± 9 years. Drug-eluting stents were used in 16 patients (64%). Clopidogrel hypersensitivity occurred 6 ± 2 days after drug initiation. Treatment included corticosteroids (5 patients), antihistamines (5 patients), or corticosteroids and antihistamines (15 patients). Patients treated with corticosteroids received tapering courses for a mean of 10 ± 8 days. Treatment was successful with sustained symptom resolution in 22 of 25 patients (88%). Clopidogrel therapy was continued in successfully desensitized patients for 417 ± 369 days and in patients with drug-eluting stents for 529 ± 376 days. There were no deaths, myocardial infarctions, or stent thrombosis during extended follow-up. In conclusion, clopidogrel hypersensitivity can be successfully treated using short-course corticosteroids and antihistamines without interrupting drug therapy. This technique enables long-term continuation of clopidogrel and confers a low risk of adverse cardiac events.
氯吡格雷超敏反应影响多达 6%的治疗患者，常导致药物停药。传统脱敏方案包括停药期，在经皮冠状动脉介入治疗后可能出现问题，因为过早停用双联抗血小板治疗是支架血栓形成的主要危险因素。本研究旨在评估一种不中断药物治疗的氯吡格雷超敏反应治疗策略，使用皮质类固醇和抗组胺药促进生理耐受的发展。研究人群由 25 例连续经皮冠状动脉介入治疗后发生氯吡格雷超敏反应的患者组成，采用皮质类固醇和抗组胺药进行抑制性治疗。评估治疗成功（无中断氯吡格雷治疗过敏症状缓解），以及氯吡格雷治疗持续时间和晚期随访期间的不良心脏事件（平均 670 ± 630 天）。该队列包括 19 名男性和 6 名女性，平均年龄 62 ± 9 岁。16 例患者（64%）使用药物洗脱支架。氯吡格雷超敏反应发生在药物开始后 6 ± 2 天。治疗包括皮质类固醇（5 例）、抗组胺药（5 例）或皮质类固醇和抗组胺药（15 例）。接受皮质类固醇治疗的患者接受了平均 10 ± 8 天的递减疗程。25 例患者中有 22 例（88%）治疗成功，症状持续缓解。脱敏成功的患者氯吡格雷治疗持续时间为 417 ± 369 天，药物洗脱支架患者为 529 ± 376 天。延长随访期间无死亡、心肌梗死或支架血栓形成。总之，氯吡格雷超敏反应可成功采用短疗程皮质类固醇和抗组胺药治疗，不中断药物治疗。该技术可实现氯吡格雷的长期持续应用，并降低不良心脏事件的风险。
