Comparing Allergist and Cardiologist Considerations for the Optimal Management of Thienopyridines Hypersensitivity.
Thienopyridines
clopidogrel
hypersensitivity
prasugrel
premedication
ticagrelor desensitization
ticlopidine.
Journal
Endocrine, metabolic & immune disorders drug targets
ISSN: 2212-3873
Titre abrégé: Endocr Metab Immune Disord Drug Targets
Pays: United Arab Emirates
ID NLM: 101269157
Informations de publication
Date de publication:
2019
2019
Historique:
received:
26
10
2017
revised:
30
04
2018
accepted:
21
06
2018
pubmed:
15
9
2018
medline:
18
5
2019
entrez:
15
9
2018
Statut:
ppublish
Résumé
The thienopyridine family includes ticlopidine, clopidogrel and prasugrel which are antiplatelet drugs largely used, mainly associated to aspirin, for treatment of acute coronary syndromes and after percutaneous coronary interventions, to avoid thrombosis. In some patients, thienpyridines may cause hypersensitivity reactions which jeopardize the optimal therapeutic and preventive approach to vascular diseases. The management of thienopyridine hypersensitivity seems to be best done as an interdisciplinary collaboration between the allergist and cardiologist. The present study investigates the management of thienopyridines hypersensitivity on the basis of published case reports and studies, comparing the pro and contro of pharmacological treatments, different desensitization protocols to thienopyridines and substitution of antiplatelet agents eaches others, according to the point of view of cardiologist and allergist. For the cardiologist, the important issues are the necessity of continuing therapy, the desired duration of therapy based on the clinical indication of the individual patient and appropriateness of using one of the alternative P2Y12 inhibitors. For the allergist, the important issues are weighing the risk and benefits of the various therapeutic options: treating "through" desensitization, or switching to an alternative agent. All the data seem to suggest that only working together, a cardio-allergy team of specialists may evaluate and offer the best approach to clinical decision-making for the individual patient.
Sections du résumé
BACKGROUND AND OBJECTIVE
OBJECTIVE
The thienopyridine family includes ticlopidine, clopidogrel and prasugrel which are antiplatelet drugs largely used, mainly associated to aspirin, for treatment of acute coronary syndromes and after percutaneous coronary interventions, to avoid thrombosis. In some patients, thienpyridines may cause hypersensitivity reactions which jeopardize the optimal therapeutic and preventive approach to vascular diseases. The management of thienopyridine hypersensitivity seems to be best done as an interdisciplinary collaboration between the allergist and cardiologist.
METHOD
METHODS
The present study investigates the management of thienopyridines hypersensitivity on the basis of published case reports and studies, comparing the pro and contro of pharmacological treatments, different desensitization protocols to thienopyridines and substitution of antiplatelet agents eaches others, according to the point of view of cardiologist and allergist. For the cardiologist, the important issues are the necessity of continuing therapy, the desired duration of therapy based on the clinical indication of the individual patient and appropriateness of using one of the alternative P2Y12 inhibitors. For the allergist, the important issues are weighing the risk and benefits of the various therapeutic options: treating "through" desensitization, or switching to an alternative agent.
RESULTS AND CONCLUSION
CONCLUSIONS
All the data seem to suggest that only working together, a cardio-allergy team of specialists may evaluate and offer the best approach to clinical decision-making for the individual patient.
Identifiants
pubmed: 30215337
pii: EMIDDT-EPUB-93077
doi: 10.2174/1871530318666180914121758
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Thienopyridines
0
Types de publication
Comparative Study
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2-12Informations de copyright
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