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Strategies for managing clopidogrel hypersensitivity should take patient-specific factors into account

  • Drug Reactions and Interactions
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Abstract

Approximately 4 % of patients receiving clopidogrel develop hypersensitivity reactions, potentially limiting the use of this treatment. Managing clopidogrel hypersensitivity can be challenging and requires consideration of patient-specific factors. Management options include avoiding clopidogrel use, overcoming the clopidogrel reaction, and switching to an alternative antiplatelet agent.

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References

  1. Plavix (clopidogrel bisulfate) tablets: US prescribing information. Bridgewater (NJ): Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; 2015.

  2. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329–39.

    Article  Google Scholar 

  3. Connolly SJ, Pogue J, Hart RG, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med. 2009;360(20):2066–78.

    Article  PubMed  Google Scholar 

  4. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44–122.

    Article  PubMed  Google Scholar 

  5. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494–502.

    Article  PubMed  CAS  Google Scholar 

  6. Plosker GL, Lyseng-Williamson KA. Clopidogrel: a review of its use in the prevention of thrombosis. Drugs. 2007;67(4):613–46.

    Article  PubMed  CAS  Google Scholar 

  7. Beavers CJ, Carris NW, Ruf KM. Management strategies for clopidogrel hypersensitivity. Drugs. 2015;75(9):999–1007.

    Article  PubMed  Google Scholar 

  8. Fajt M, Petrov A. Clopidogrel hypersensitivity: a novel multi-day outpatient oral desensitization regimen. Ann Pharmacother. 2010;44(1):11–8.

    Article  PubMed  CAS  Google Scholar 

  9. Cheema AN, Mohammad A, Hong T, et al. Characterization of clopidogrel hypersensitivity reactions and management with oral steroids without clopidogrel discontinuation. J Am Coll Cardiol. 2011;58(14):1445–54.

    Article  PubMed  CAS  Google Scholar 

  10. Campbell KL, Cohn JR, Fischman DL, et al. Management of clopidogrel hypersensitivity without drug interruption. Am J Cardiol. 1076;2011:812–6.

    Google Scholar 

  11. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–15.

    Article  PubMed  CAS  Google Scholar 

  12. Pirmohamed M. Genetic factors in the predisposition to drug induced hypersensitivity reactions. AAPS J. 2006;8(1):E20–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Vigo PG, Mac Dowell AL, Wedner HJ. Successful desensitization with clopidogrel after a positive skin test. Ann Allergy Asthma. 2005;94:131.

  14. Gutierrez-Fernandez D, Fuentes-Vallejo MS, Rueda-Ygueravides MD, et al. Immediate hypersensitivity and delayed hypersensitivity to clopidogrel. Allergol Immunopathol (Madr). 2007;35(5):213–5.

    Article  PubMed  CAS  Google Scholar 

  15. Cochran ST. Anaphylactoid reactions to radiocontrast media. Curr Allergy Asthma Rep. 2005;5(1):28–31.

    Article  PubMed  CAS  Google Scholar 

  16. Camara MG, Almeda FQ. Clopidogrel (Plavix) desensitization: a case series. Catheter Cardiovasc Interv. 2005;65(4):525–7.

    Article  PubMed  Google Scholar 

  17. Lee-Wong M, Gadhvi D, Resnick D. Clopidogrel desensitization. Ann Allergy Asthma Immunol. 2006;96(5):756–7.

    Article  PubMed  Google Scholar 

  18. Oppedijk B, Odekerken DA, van der Wildt JJ, et al. Rapid oral desensitisation procedure in clopidogrel hypersensitivity. Neth Heart J. 2008;16(1):21–3.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Walker NE, Fasano MB, Horwitz PA. Desensitization for the management of clopidogrel hypersensitivity: initial clinical experience. J Invasive Cardiol. 2006;18(7):341–4.

    PubMed  Google Scholar 

  20. Walker NE, Fasano MB, Hobbs RA, et al. Clopidogrel desensitization protocol for the treatment of thienopyridine hypersensitivity. Crit Pathw Cardiol. 2007;6(1):26–9.

    Article  PubMed  Google Scholar 

  21. Barreira P, Cadinha S, Malheiro D, et al. Desensitization to clopidogrel: a tailor-made protocol. Eur Ann Allergy Clin Immunol. 2014;46(1):53–5.

  22. Wallentin L, Becker RC, Budaj A. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.

    Article  PubMed  CAS  Google Scholar 

  23. Binazon O, Dubois-Gauche A, Nanau RM, et al. Efficacy and safety of platelet inhibitors. J Pharm Pharm Sci. 2013;16(1):1–39.

    PubMed  Google Scholar 

  24. Moussa I, Oetgen M, Roubin G, et al. Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation. 1999;99(18):2364–6.

    Article  PubMed  CAS  Google Scholar 

  25. Bertrand ME, Rupprecht HJ, Urban P, et al. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation. 2000;102(6):624–9.

    Article  PubMed  CAS  Google Scholar 

  26. Biondi-Zoccai GG, Agostoni P, Sangiorgi GM, et al. Comparison of ticlopidine vs. clopidogrel in addition to aspirin after paclitaxel-eluting stent implantation: insights from the TRUE (Taxusin Real-life Usage Evaluation) Study. Int J Cardiol. 2006;108(3):406–7.

    Article  PubMed  Google Scholar 

  27. Mueller C, Roskamm H, Neumann FJ, et al. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary artery stents. J Am Coll Cardiol. 2003;41(6):969–73.

    Article  PubMed  CAS  Google Scholar 

  28. Lokhandwala JO, Best PJ, Butterfield JH, et al. Frequency of allergic or hematologic adverse reactions to ticlopidine among patients with allergic or hematologic adverse reactions to clopidogrel. Circ Cardiovasc Interv. 2009;2(4):348–51.

    Article  PubMed  Google Scholar 

  29. Vandvik PO, Lincoff AM, Gore JM, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2Suppl):e637S–68S.

  30. Han Y, Wang S, Li Y, et al. Cilostazol improves long-term outcomes after coronary stent implantation. Am Heart J. 2005;150(3):568.

    Article  PubMed  Google Scholar 

  31. Lee SW, Park SW, Hong MK, et al. Comparison of cilostazol and clopidogrel after successful coronary stenting. Am J Cardiol. 2005;95(7):859–62.

    Article  PubMed  CAS  Google Scholar 

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The article was adapted from Drugs 2015;75:999–1007 [7] by salaried employees of Adis/Springer and was not supported by any external funding.

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Adis Medical Writers. Strategies for managing clopidogrel hypersensitivity should take patient-specific factors into account. Drugs Ther Perspect 32, 22–26 (2016). https://doi.org/10.1007/s40267-015-0261-6

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  • DOI: https://doi.org/10.1007/s40267-015-0261-6

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