Harris Justin R, Coons James C
UPMC Presbyterian Hospital, Pittsburg, PA, USA
UPMC Presbyterian Hospital, Pittsburg, PA, USA.
Ann Pharmacother. 2014 Sep;48(9):1230-1233. doi: 10.1177/1060028014539143. Epub 2014 Jun 23.
To report the use of ticagrelor in a patient with a documented hypersensitivity reaction to clopidogrel.
A 64-year-old woman presented with non-ST-segment elevation myocardial infarction (NSTEMI) with a history significant for a hypersensitivity reaction to clopidogrel and was medically managed. Based on the patient's past medical history and current evidence available, the determination was made to use ticagrelor in this patient. Ticagrelor was administered without reaction during the hospital stay and on assessment at 2 and 4 weeks postdischarge.
Hypersensitivity occurs in approximately 1% of patients receiving clopidogrel. Although the risk of hypersensitivity reaction to clopidogrel is low, evidence to support alternative antiplatelets in this setting is relatively limited. Prasugrel has a similar structure to clopidogrel and, therefore, may cross-react. Furthermore, prasugrel is not recommended in the medical management of NSTEMI. Ticagrelor is a newer P2Y12 inhibitor that contains a cyclopentyltriazolopyrimidine structure. Because of the difference in structure, a lower theoretical risk of cross-reactivity with the thienopyridines would be anticipated. However, there are no reports to date that investigate the use of this agent in patients with a documented thienopyridine allergy.
The current case report describes the use of ticagrelor in a patient with documented hypersensitivity to clopidogrel. In this patient, ticagrelor was well tolerated during hospital admission and at 2 and 4 weeks postdischarge following administration.
报告替格瑞洛在有氯吡格雷超敏反应记录患者中的应用。
一名64岁女性因非ST段抬高型心肌梗死（NSTEMI）就诊，有氯吡格雷超敏反应史，接受药物治疗。根据患者既往病史和现有证据，决定在该患者中使用替格瑞洛。住院期间及出院后2周和4周评估时给予替格瑞洛，未出现不良反应。
接受氯吡格雷治疗的患者中约1%会发生超敏反应。尽管氯吡格雷超敏反应的风险较低，但在这种情况下支持使用替代抗血小板药物的证据相对有限。普拉格雷与氯吡格雷结构相似，因此可能会发生交叉反应。此外，不推荐在NSTEMI的药物治疗中使用普拉格雷。替格瑞洛是一种较新的P2Y12抑制剂，含有环戊基三唑并嘧啶结构。由于结构不同，预计与噻吩并吡啶类药物交叉反应的理论风险较低。然而，迄今为止尚无关于在有噻吩并吡啶类药物过敏记录的患者中使用该药物的报道。
本病例报告描述了替格瑞洛在有氯吡格雷超敏反应记录患者中的应用。在该患者中，住院期间及给药后出院2周和4周时，替格瑞洛耐受性良好。
