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CARDIOLOGY

Clopidogrel Hypersensitivity: A Novel Multi-Day Outpatient Oral Desensitization Regimen

Fellow in Allergy-Immunology, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

Andrej Petrov, MD

Assistant Professor of Medicine, School of Medicine, University of Pittsburgh; Medical Director, Allergy and Clinical Immunology, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center; Associate Program Director of Allergy-Immunology Fellowship, School of Medicine, University of Pittsburgh

Reprints: Dr. Petrov, Division of Pulmonary, Allergy and Critical Care Medicine, UPMC Montefiore, NW 628, 3459 Fifth Ave., Pittsburgh, PA 15213, fax 412/692-2260, petrovaa{at}upmc.edu

BACKGROUND: Clopidogrel hypersensitivity has posed a problem for the acute treatment and long-term care of a particular patient population with coronary artery disease and stent placement. Patients with clopidogrel hypersensitivity have had an increased risk of hypersensitivity reactions, including anaphylaxis, if they ingest clopidogrel without undergoing an oral desensitization procedure. The previously published desensitization protocols have either been performed in the intensive care unit, requiring significant cost and healthcare utilization, or have required a full-day outpatient commitment on behalf of the patient.

OBJECTIVE: To determine whether a multi-day outpatient oral clopidogrel desensitization protocol is effective and safe for patients with clopidogrel hypersensitivity.

METHODS: We retrospectively assessed the efficacy of a 10-dose outpatient multi-day clopidogrel desensitization protocol performed in a university allergy-immunology center from April 2006 to October 2008 in patients with clopidogrel hypersensitivity. Patients were desensitized over 2-3 half-day clinical visits and were able to go home between desensitization sessions. A preliminary cost analysis was performed using the average of actual costs for the outpatient clopidogrel desensitization procedure and was compared with the average cost for an inpatient oral desensitization completed at our institution.

RESULTS: Eight patients with coronary artery disease, cardiac stent placement, and clopidogrel hypersensitivity underwent an outpatient multi-day oral clopidogrel desensitization procedure. All patients were successfully desensitized with the multi-day protocol without complications. No patient had recurrence of allergic reaction 3 months after the procedure. A preliminary cost analysis demonstrated a lower cost for the outpatient compared to the inpatient oral clopidogrel desensitization protocol.

CONCLUSIONS: This outpatient 10-dose multi-day clopidogrel desensitization protocol is a safe and effective novel approach for the treatment of clopidogrel hypersensitivity in patients with coronary artery disease and cardiac stent placement. In addition to safety and efficacy, this protocol offers the patient the convenience of avoiding hospital admission or full-day time commitments.

Key Words: cardiac stent treatment, clopidogrel hypersensitivity, drug desensitization

Published Online, December 15, 2009. www.theannals.com, DOI 10.1345/aph.1M379