ORIGINAL ARTICLE   

Minerva Cardioangiologica 2019 April;67(2):94-101

DOI: 10.23736/S0026-4725.19.04787-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Management of aspirin intolerance in patients undergoing percutaneous coronary intervention. The role of mono-antiplatelet therapy: a retrospective, multicenter, study

Matteo BIANCO ¹ ✉, Carol GRAVINESE ¹, Enrico CERRATO ², Iván NUÑEZ-GIL ³, Paola DESTEFANIS ¹, Alessia LUCIANO ¹, Simone BISCAGLIA ⁴, Giorgio QUADRI ², Emanuele TIZZANI ⁵, Antonella CORLETO ⁵, Sara GIOLITTO ⁵, Luca LO SAVIO ⁵, Gianluca CAMPO ⁴, Ferdinando VARBELLA ², Roberto POZZI ¹

¹ Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy; ² Interventional Cardiology Unit, Infermi Hospital, Rivoli and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy; ³ San Carlos Clinical Hospital, Madrid, Spain; ⁴ Cardiovascular Institute, University Hospital, Cona, Ferrara, Italy; ⁵ Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy

BACKGROUND: The optimal management of patients with aspirin intolerance undergoing stent implantation represents a challenge for physicians. The aim of this study was to assess the overall number of patients discharged with mono antiplatelet therapy after percutaneous coronary intervention (PCI). The most frequent aspirin intolerance symptoms in this population and the overall incidence of patient-oriented composite endpoints (POCE).
METHODS: From January 2006 to June 2016 all patients discharged with mono-antiplatelet therapy because of aspirin intolerance/hypersensitivity/allergy and treated by means of PCI were included. Data about percutaneous treatments and aspirin intolerance were collected. POCE were evaluated at a twelve-month clinical follow-up comparing safety and efficacy of clopidogrel monotherapy versus new P2Y12 inhibitors.
RESULTS: We collected 70 patients, that is 0.3% of the total amount of PCI in the considered period, 25 (35%) of them were women and the remaining 45 (65%) were men. An acute coronary syndrome (ACS) was the clinical presentation in 47 (67.1%) patients, with NSTEMI in 19 (27.1%) of them. Forty-six patients (65.7%) were treated with clopidogrel and 24 (34.3%) with new P2Y12 inhibitors. At one-year follow-up, 18 (25.7%) patients suffered a new clinically relevant adverse event, 5 (7.1%) died, 3 (4.3%) required a target vessel revascularization and 10 (14.3%) patients a target lesion revascularization.
CONCLUSIONS: Our study evaluated patients with ACS or stable coronary artery disease undergoing PCI and treated with mono-antiplatelet therapy with P2Y12 inhibitors due to aspirin intolerance shows a 25% incidence of POCE at one year. Further studies with adequate sample size are required to evaluate the efficacy and safety of mono antiplatelet therapy in this clinical scenario.

KEY WORDS: Aspirin, intolerance; Percutaneous coronary intervention; Receptors, purinergic P2Y12, inhibition