Córdoba-Soriano Juan Gabriel, Corbí-Pascual Miguel, López-Neyra Isabel, Navarro-Cuartero Javier, Hidalgo-Olivares Víctor, Barrionuevo-Sánchez Maria Isabel, Prieto-Mateos Daniel, Gutiérrez-Díez Antonio, Gallardo-López Arsenio, Fuentes-Manso Raquel, Gómez-Pérez Alberto, Lafuente-Gormaz Carlos, Jiménez-Mazuecos Jesús
Cardiology Department, Hospital General Universitario de Albacete, Albacete, Spain.
Eur Heart J Acute Cardiovasc Care. 2016 Nov;5(7):41-50. doi: 10.1177/2048872615618509. Epub 2016 Sep 22.
Aspirin hypersensitivity is not a rare condition among patients with acute coronary syndrome. However, despite the publication of several successful desensitization protocols, the procedure is not as widespread as expected. We present a cohort of patients with acute coronary syndrome undergoing aspirin desensitization to evaluate its short- and long-term efficacy and safety and to reinforce data from previous studies.
Of 1306 patients admitted to our Coronary Care Unit between February 2011 and February 2013, 24 (1.8%) had a history of aspirin hypersensitivity. All 24 patients underwent an eight-dose aspirin desensitization protocol (0.1, 0.3, 1, 3, 10, 25, 50 and 100 mg of aspirin given by mouth every 15 minutes) after premedication with antihistamines and corticosteroids or antileucotrienes. Previously prescribed β blockers and angiotensin-converting enzyme inhibitors were not discontinued. All patients were desensitized within 72 hours of admission. Those requiring urgent catheterization (five patients with ST segment elevation myocardial infarction) were desensitized within 12 hours of catheterization and the remainder before catheterization.
All patients were successfully desensitized and only one presented with an urticarial reaction. The five patients with ST segment elevation myocardial infarction were treated with abciximab until desensitization was complete. All but one patient underwent catheterization and 20 underwent percutaneous coronary intervention, most (66%) with the implantation of a bare metal stent. At follow-up (a minimum of 6-24 months), only two patients had discontinued aspirin, both due to gastrointestinal bleeding, and no hypersensitivy reaction had occurred.
Aspirin desensitization is effective and safe in unstable patients with acute coronary syndrome in both the short and long term.
阿司匹林超敏反应在急性冠脉综合征患者中并非罕见。然而，尽管已发表了几种成功的脱敏方案，但该程序并未如预期那样广泛应用。我们呈现一组接受阿司匹林脱敏的急性冠脉综合征患者，以评估其短期和长期疗效及安全性，并补充先前研究的数据。
在2011年2月至2013年2月期间入住我们冠心病监护病房的1306例患者中，24例（1.8%）有阿司匹林超敏反应病史。所有24例患者在使用抗组胺药、皮质类固醇或抗白三烯药物进行预处理后，接受了八剂量阿司匹林脱敏方案（每15分钟口服0.1、0.3、1、3、10、25、50和100毫克阿司匹林）。先前开具的β受体阻滞剂和血管紧张素转换酶抑制剂未停用。所有患者在入院72小时内完成脱敏。那些需要紧急导管插入术的患者（5例ST段抬高型心肌梗死患者）在导管插入术后12小时内完成脱敏，其余患者在导管插入术前完成脱敏。
所有患者均成功脱敏，仅1例出现荨麻疹反应。5例ST段抬高型心肌梗死患者在脱敏完成前接受了阿昔单抗治疗。除1例患者外，所有患者均接受了导管插入术，20例接受了经皮冠状动脉介入治疗，大多数（66%）植入了裸金属支架。在随访（至少6 - 24个月）时，仅2例患者因胃肠道出血停用了阿司匹林，且未发生过敏反应。
阿司匹林脱敏在急性冠脉综合征不稳定患者中短期和长期均有效且安全。
