Key result
Antiplatelet desensitization succeeds in patient with triple P2Y12 inhibitor cross-reactive hypersensitivity.
Why the study?
Cross-reactive hypersensitivity among oral antiplatelet agents including clopidogrel, prasugrel, and ticagrelor is not well documented and poses clinical management challenges.
Case Report (n=1)
Cross-reactive hypersensitivity can occur between structurally dissimilar P2Y12 inhibitors (thienopyridines and cyclopentyl-triazolo-pyrimidines) but can be managed with successful desensitisation.
Alerts clinicians to P2Y12 inhibitor allergies; leaves open cross-reactivity and safe alternatives.
Oral platelet aggregation inhibitors are widely used for the treatment and prevention of cardiovascular diseases, including coronary stent thrombosis. Premature discontinuation following percutaneous coronary intervention would pose a grave risk of in-stent thrombosis, acute myocardial infarction and eventual death. Although they share the same mechanism of adenosine diphosphate P2Y12 platelet receptor inhibition, they belong to either the chemical class of thienopyridines (clopidogrel, prasugrel, and ticlopidine) or cyclopentyl-triazolo-pyrimidines (ticagrelor and cangrelor). This case describes the first documented cross-reactive hypersensitivity of clopidogrel towards both its fellow thienopyridine, prasugrel, as well as the structurally dissimilar ticagrelor, and its subsequent successful desensitisation.
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Chin et al. (2015) conducted a case report in Oral antiplatelet agent hypersensitivity (n=1). Desensitisation was evaluated on Successful desensitisation. Desensitisation was successfully performed in a patient with documented cross-reactive hypersensitivity to clopidogrel, prasugrel, and ticagrelor.
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