Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
Hong Kong Med J. 2013 Jun;19(3):207-13. doi: 10.12809/hkmj133914. Epub 2013 May 6.
OBJECTIVE. To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease. DESIGN. Case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal anti-inflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012. RESULTS. There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt. No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation. CONCLUSION. Given the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.
目的。评估阿司匹林脱敏在冠心病中国患者中的疗效和安全性。设计。病例系列。地点。中国香港一家地区医院。患者。有阿司匹林或非甾体抗炎药过敏史的冠心病患者，于 2008 年 2 月至 2012 年 7 月期间接受阿司匹林脱敏。结果。在此期间，共有 24 例冠心病患者因需要脱敏而被收入我院。大多数患者（79%）因脱敏而入院；8 例（33%）在脱敏过程中发生过敏反应。其中一半仅有局限性皮肤反应，并能完成脱敏方案并产生阿司匹林耐受。总体而言，20 例（83%）患者在首次尝试时成功脱敏。该队列中未发生严重不良反应。12 例患者通过冠状动脉造影显示有明显的冠状动脉疾病，并接受了经皮冠状动脉介入治疗，其中 9 例接受了药物洗脱支架，3 例因经济限制而接受了裸金属支架。所有 11 例成功脱敏的患者在经皮冠状动脉介入治疗后均接受阿司匹林和氯吡格雷双重抗血小板治疗。其余 1 例患者因阿司匹林脱敏失败而植入裸金属支架。结论。鉴于不同种族人群阿司匹林过敏的潜在遗传基础可能不同，以前尚未探讨在华人群中进行脱敏的问题。本研究表明，使用快速方案可以有效地、安全地在冠心病中国患者中进行阿司匹林脱敏。我们的结果与其他涉及其他种族的已发表研究结果相当。成功的阿司匹林脱敏可使患者在经皮冠状动脉介入治疗后长期接受双重抗血小板治疗（包括阿司匹林），从而使药物洗脱支架成为可行的选择。
