Vasculitis de pequeño vaso asociado al uso de clopidogrel en síndrome coronario agudo: un reto diagnóstico y terapéutico

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Clopidogrel-associated cutaneous small-vessel vasculitis following percutaneous coronary intervention for acute coronary syndrome (n=1). Intervention: Clopidogrel discontinuation, prednisolone taper, and switch to rivaroxaban plus acetylsalicylic acid. Primary outcome: Resolution of cutaneous vasculitic lesions and freedom from ischemic or thrombotic complications.

Q: What does this research mean for the field?

Clopidogrel withdrawal, corticosteroid therapy, and transition to rivaroxaban plus aspirin resolves clopidogrel-associated small vessel vasculitis without causing short-term thrombotic complications. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Juanita Velásquez-Ospina; Jorge Alejandro Pamplona-Tobón Jorge Alejandro Pamplona-Tobón; Natalia Mejía-Zapata; Santiago Patiño-Giraldo; Maria C. Gaviria-Aguilar

doi:10.35366/124269

January 1, 2026Revista Mexicana de CardiologíaOpen Access

Vasculitis de pequeño vaso asociado al uso de clopidogrel en síndrome coronario agudo: un reto diagnóstico y terapéutico

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Why the study?

Hypersensitivity reactions to clopidogrel are rare, and type III hypersensitivity such as small vessel vasculitis presents a diagnostic and therapeutic challenge in acute coronary syndrome patients.

Key Points

To describe a rare presentation of type III hypersensitivity manifesting as leukocytoclastic small vessel vasculitis induced by clopidogrel following percutaneous coronary intervention for acute coronary syndrome.
Clinical case report of a patient with atrial fibrillation presenting with unstable angina who underwent percutaneous coronary intervention with a drug-eluting stent to the circumflex artery.
Workup performed to exclude systemic involvement and secondary etiologies following the onset of generalized palpable purpuric lesions after clopidogrel therapy.
Management involved clopidogrel withdrawal, systemic corticosteroid administration, and antithrombotic regimen adjustment to rivaroxaban 15 mg daily plus acetylsalicylic acid 100 mg daily.
Cutaneous purpuric lesions showed complete resolution 20 days after onset following clopidogrel discontinuation and corticosteroid therapy.
No ischemic or thrombotic complications were observed during the one-month follow-up period on the adjusted rivaroxaban and aspirin regimen.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

An 87-year-old woman in Colombia with atrial fibrillation and recent drug-eluting stent implantation for unstable angina who developed clopidogrel-induced cutaneous small-vessel vasculitis, followed for 1 month after treatment modification.

I

Intervention

Discontinuation of clopidogrel, oral prednisolone 0.5 mg/kg for two weeks followed by a gradual reduction of 5 mg per week until discontinuation, and modification of antithrombotic therapy to rivaroxaban 15 mg once daily plus acetylsalicylic acid 100 mg once daily.

O

Outcome

Clinical resolution of cutaneous purpuric lesions and absence of ischemic or thrombotic complications at 1-month follow-up.safety

Limitations

Single-patient case report
Skin biopsy for histopathological confirmation of leukocytoclastic vasculitis was deferred
Skin biopsy for histopathological confirmation was deferred
Single case report with 1-month follow-up

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Implication

Illustrates that rare clopidogrel-induced cutaneous small-vessel vasculitis after recent PCI in a patient with atrial fibrillation can be successfully managed by discontinuing clopidogrel, administering a short corticosteroid course, and transitioning to rivaroxaban plus low-dose aspirin.

Abstract

El tratamiento de síndrome coronario agudo incluye el uso de ácido acetil salicílico y un inhibidor de P2Y12, siendo el clopidogrel el más utilizado en la práctica clínica.Afortunadamente, las reacciones adversas por hipersensibilidad con el clopidogrel son inusuales, sin embargo, cuando ocurren, por lo general son tipo I mediadas por IgE (urticaria, angioedema y erupción cutánea).Las reacciones de hipersensibilidad tipo III como la vasculitis de pequeño vaso son extremadamente raras y suponen un reto terapéutico, sobre todo en el contexto de un síndrome coronario agudo (SCA).Este trabajo evidencia la presentación de una reacción infrecuente que debería tenerse presente en pacientes con terapia antiagregante.

Discussion

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Cite This Study

Velásquez-Ospina et al. (2026) conducted a case report in Clopidogrel-associated cutaneous small-vessel vasculitis following percutaneous coronary intervention for acute coronary syndrome (n=1). Clopidogrel discontinuation, prednisolone taper, and switch to rivaroxaban plus acetylsalicylic acid was evaluated on Resolution of cutaneous vasculitic lesions and freedom from ischemic or thrombotic complications.

synapsesocial.com/papers/6ac5d8a93d5adfbd40183d8a https://doi.org/10.35366/124269

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Vasculitis de pequeño vaso asociado al uso de clopidogrel en síndrome coronario agudo: un reto diagnóstico y terapéutico

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Vasculitis de pequeño vaso asociado al uso de clopidogrel en síndrome coronario agudo: un reto diagnóstico y terapéutico

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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