Aspirin hypersensitivity: a practical guide for cardiologists.
Silvia GrimaldiPaola MiglioriniIlaria PuxedduRoberta RossiniRaffaele De CaterinaPublished in: European heart journal (2024)
Aspirin has been known for a long time and currently stays as a cornerstone of antithrombotic therapy in cardiovascular disease. In patients with either acute or chronic coronary syndromes undergoing percutaneous coronary intervention aspirin is mandatory in a dual antiplatelet therapy regimen for prevention of stent thrombosis and/or new ischaemic events. Aspirin is also currently a first-option antithrombotic therapy after an aortic prosthetic valve replacement and is occasionally required in addition to oral anticoagulants after implantation of a mechanical valve. Presumed or demonstrated aspirin hypersensitivity is a main clinical problem, limiting the use of a life-saving medication. In the general population, aspirin hypersensitivity has a prevalence of 0.6%-2.5% and has a plethora of clinical presentations, ranging from aspirin-exacerbated respiratory disease to anaphylaxis. Although infrequent, when encountered in clinical practice aspirin hypersensitivity poses for cardiologists a clinical dilemma, which should never be trivialized, avoiding-as much as possible-omission of the drug. We here review the epidemiology of aspirin hypersensitivity, provide an outline of pathophysiological mechanisms and clinical presentations, and review management options, starting from a characterization of true aspirin allergy-in contrast to intolerance-to suggestion of desensitization protocols.
Keyphrases
- antiplatelet therapy
- percutaneous coronary intervention
- low dose
- acute coronary syndrome
- cardiovascular events
- coronary artery disease
- cardiovascular disease
- drug induced
- atrial fibrillation
- st segment elevation myocardial infarction
- acute myocardial infarction
- coronary artery bypass grafting
- st elevation myocardial infarction
- aortic valve
- risk factors
- clinical practice
- anti inflammatory drugs
- oral anticoagulants
- healthcare
- coronary artery
- stem cells
- heart failure
- magnetic resonance
- cardiovascular risk factors
- emergency department
- computed tomography
- mitral valve
- pulmonary artery
- pulmonary arterial hypertension
- metabolic syndrome
- aortic dissection
- bone marrow
- mesenchymal stem cells
- liver failure
- adverse drug
- replacement therapy