Aspiring desensitization therapy is safe and effective in patients with acute coronary syndrome

New research suggests that acetylsalicylic acid (ASA) desensitization therapy is safe and effective in patients with acute coronary syndrome (ACS). The meta-analysis published July 1, 2019 in the American Journal of Cardiology found that 98% of the patients were able to complete an aspirin-introduction protocol and continue aspirin until discharge, without symptoms of hypersensitivity.

After a PubMed database search, 15 reports consisting of 480 ACS patients with previous hypersensitivity to ASA were included in the meta-analysis. The primary end point was desensitization protocol success. Hypersensitivity adverse events and ASA discontinuation due to hypersensitivity adverse events at follow-up were the secondary end points.

·         The pooled desensitization success rate was 98.3% (95% confidence interval: 97.2% to 99.5%). There was no statistical difference in outcomes between protocols ≤ 2 hours and > 2 hours in duration (96.3[92.3 to 100.3]% vs 97.2 [94.6 to 99.8]%; p = 0.71).

·         Protocols with > 6 dose escalations were associated with higher success rates compared to those with ≤ 6 doses (99.2[97.9 to 100.4]% vs 95.4[93 to 97.8]%; p = 0.007).

·         Zero hypersensitivity adverse events were reported at follow-up between 1 and 46 months. Consequently, no ASA discontinuations were related to hypersensitivity adverse events.

According to the study, protocols with > 6 dose escalations may be optimal for ASA desensitization in ACS patients.

(Source: Uptodate; Am J Cardiol. 2019 Jul 1;124(1):14-19)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA