Key result
An alternative antithrombotic regimen of ticagrelor and low-dose rivaroxaban provided effective ischemic risk mitigation without hypersensitivity reactions in an aspirin-intolerant patient with acute coronary syndrome undergoing percutaneous coronary intervention.
Why the study?
Aspirin intolerance in patients presenting with acute coronary syndrome poses clinical challenges, requiring viable alternative antithrombotic strategies when standard dual antiplatelet therapy cannot be used.
Case Report (n=1)
A combination of ticagrelor and low-dose rivaroxaban may serve as a viable alternative to aspirin-based dual antiplatelet therapy in patients with acute coronary syndrome and severe aspirin intolerance undergoing PCI.
Alternative antithrombotic strategies may be feasible in aspirin-intolerant ACS; leaves open optimal regimens and safety in larger studies.
Acute coronary syndrome (ACS) requires prompt intervention to prevent myocardial ischemia. This case report describes a patient’s clinical journey, highlighting the challenges associated with aspirin intolerance and the necessity of an alternative antithrombotic approach. The patient, who presented with ACS and a documented history of aspirin-induced asthma and angioedema, was unable to undergo standard dual antiplatelet therapy (DAPT) with aspirin. Given the urgency of intervention and failed prior aspirin desensitization, ticagrelor and rivaroxaban were selected as alternative agents. The patient underwent successful percutaneous coronary intervention (PCI) with stent placement and was managed postoperatively using a modified antithrombotic regimen. The case underscores the importance of individualized therapy in aspirin-intolerant ACS patients and suggests a viable alternative strategy for anticoagulation and platelet inhibition. Patient outcomes were favorable, demonstrating effective ischemic risk mitigation without aspirin-related hypersensitivity reactions.
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Janpaizov et al. (2025) conducted a case report in Acute coronary syndrome with aspirin intolerance (n=1). Ticagrelor and rivaroxaban was evaluated on Clinical outcome (ischemic risk mitigation and absence of hypersensitivity reactions). An alternative antithrombotic regimen of ticagrelor and low-dose rivaroxaban provided effective ischemic risk mitigation without hypersensitivity reactions in an aspirin-intolerant patient with acute coronary syndrome undergoing percutaneous coronary intervention.
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