Abstract 4123480: Navigating Aspirin Allergy With Rapid Desensitization In A Patient Requiring Urgent Coronary Intervention

Introduction: Aspirin (ASA) hypersensitivity is a challenge in determining the appropriate, cost-effective therapy in patients after percutaneous coronary intervention (PCI). Various ASA desensitization protocols were studied and showed favorable outcomes. In this case, we highlight the use of rapid ASA desensitization protocols for patients requiring dual antiplatelet therapy (DAPT) post urgent PCI. Case: A 52-year-old male presented with severe left-sided chest pain associated with diaphoresis. He had a history of allergic reaction to ASA at the age of 18 years with swelling of the face and throat without shortness of breath or hypotension. Physical examination was unremarkable except for tachycardia. Workup showed no ECG abnormalities but significantly elevated, uptrending high sensitivity troponin. Medical management included clopidogrel load, heparin drip, and nitropaste for persistent pain. Urgent coronary angiography showed a severe bifurcating lesion in the LCx and OM1 arteries, successfully treated with the T stent technique using a drug-eluting stent. He received cilostazol and prasugrel, overlapped with a tirofiban drip post PCI. ASA desensitization was performed with oral ASA every 90 minutes for four doses (Figure). Vital signs were monitored every 30, 60, and 90 minutes after each dose. He was discharged home with no reported symptoms on follow up. Discussion: DAPT with ASA and oral P2Y12 inhibitors is recommended for patients with PCI. ASA desensitization could be considered for patients who are intolerant to ASA. Major clinical ASA desensitization protocols, like in ADAPTED and SCRIPPS studies, showed good outcomes in major adverse cardiovascular events. However, one limitation of these widely used protocols is the prolonged time required to achieve desensitization. The rapid protocol used in our patient who did not have ASA exacerbated respiratory disease showed effectiveness with shorter hospital stay. Conclusion: ASA desensitization is an appropriate option for patients with a history of ASA allergy requiring DAPT. Rapid desensitization protocols are associated with shorter hospitalization courses, and future efforts should evaluate their effectiveness in randomized controlled trials.