Asia Pac Allergy.  2015 Jan;5(1):51-54. 10.5415/apallergy.2015.5.1.51.

Oral antiplatelet agent hypersensitivity and cross-reactivity managed by successful desensitisation

• Chin N
• Rangamuwa
• Mariasoosai R
• Carnes J
• Thien F

• KMID: 2397068
• DOI: http://doi.org/10.5415/apallergy.2015.5.1.51

Abstract

Oral platelet aggregation inhibitors are widely used for the treatment and prevention of cardiovascular diseases, including coronary stent thrombosis. Premature discontinuation following percutaneous coronary intervention would pose a grave risk of in-stent thrombosis, acute myocardial infarction and eventual death. Although they share the same mechanism of adenosine diphosphate P2Y12 platelet receptor inhibition, they belong to either the chemical class of thienopyridines (clopidogrel, prasugrel, and ticlopidine) or cyclopentyl-triazolo-pyrimidines (ticagrelor and cangrelor). This case describes the first documented cross-reactive hypersensitivity of clopidogrel towards both its fellow thienopyridine, prasugrel, as well as the structurally dissimilar ticagrelor, and its subsequent successful desensitisation.

Keyword

Platelet aggregation inhibitors; Hypersensitivity; Cross reactions; Desensitization, immunologic

MeSH Terms

Adenosine Diphosphate
Blood Platelets
Cardiovascular Diseases
Cross Reactions
Desensitization, Immunologic
Hypersensitivity*
Myocardial Infarction
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Prasugrel Hydrochloride
Stents
Thienopyridines
Thrombosis
Adenosine Diphosphate
Platelet Aggregation Inhibitors
Prasugrel Hydrochloride
Thienopyridines

Figure

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  Fig. 1 Structurally dissimilar base chemical structures of clopidogrel and ticagrelor. Note the base chemical structure similarity of clopidogrel and ticlopidine, and to a lesser extent prasugrel.

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