Discontinuation of clopidogrel and aspirin with initiation of indobufen and corticosteroids led to complete resolution of DIHS symptoms, no stent thrombosis, and no recurrent gastrointestinal bleeding over 24 months in a 70-year-old male after PCI.
Case Report (n=1)
No
Does indobufen monotherapy safely prevent stent thrombosis while allowing management of clopidogrel-induced DIHS and gastrointestinal bleeding in a post-PCI patient?
Indobufen monotherapy combined with corticosteroids may serve as a feasible contingency strategy for managing life-threatening clopidogrel-induced DIHS and active bleeding post-PCI without causing stent thrombosis.
Background Drug-induced hypersensitivity syndrome (DIHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS), is a rare but potentially life-threatening adverse drug reaction. Clopidogrel induced DHS following percutaneous coronary intervention (PCI) presents a unique therapeutic challenge due to the critical need for dual antiplatelet therapy to prevent stent thrombosis. Case summary A 70-year-old male underwent emergency PCI with multiple stent implantation for unstable angina with three-vessel coronary disease. Standard dual antiplatelet therapy (aspirin 100 mg daily and clopidogrel 75 mg daily) was initiated post-procedure. One hour after PCI, the patient developed anaphylactic shock initially attributed to contrast agent allergy. Two weeks post-discharge, he presented with recurrent skin rash, hypotension, gastrointestinal bleeding, fever, and eosinophilia, consistent with DIHS. Multidisciplinary consultation confirmed clopidogrel-induced DIHS using established diagnostic criteria. Despite the high risk of stent thrombosis, dual antiplatelet therapy was discontinued due to life-threatening complications. The patient was successfully managed with indobufen and low dose corticosteroids, resulting in complete symptom resolution. Conclusion This case highlights the diagnostic complexity of clopidogrel-induced DIHS and presents the detailed account of successful management of it. Early recognition using standardized diagnostic criteria and multidisciplinary management are crucial for patient outcomes.
Wang et al. (Tue,) conducted a case report in Clopidogrel-induced drug-induced hypersensitivity syndrome (DIHS) / DRESS syndrome following percutaneous coronary intervention (PCI) (n=1). Discontinuation of clopidogrel and aspirin; initiation of indobufen 100 mg twice daily and prednisolone 1 mg/kg/day (70 mg daily) with supportive care including proton pump inhibitors and fluid management was evaluated on Resolution of clopidogrel-induced DIHS symptoms, prevention of stent thrombosis, and control of gastrointestinal bleeding. Discontinuation of clopidogrel and aspirin with initiation of indobufen and corticosteroids led to complete resolution of DIHS symptoms, no stent thrombosis, and no recurrent gastrointestinal bleeding over 24 months in a 70-year-old male after PCI.