New research suggests that acetylsalicylic acid (ASA) desensitization therapy is safe and effective in patients with acute coronary syndrome (ACS). The meta-analysis published July 1, 2019 in the American Journal of Cardiology found that 98% of the patients were able to complete an aspirin-introduction protocol and continue aspirin until discharge, without symptoms of hypersensitivity.
After a PubMed database search, 15 reports consisting of 480 ACS patients with previous hypersensitivity to ASA were included in the meta-analysis. The primary end point was desensitization protocol success. Hypersensitivity adverse events and ASA discontinuation due to hypersensitivity adverse events at follow-up were the secondary end points.
- The pooled desensitization success rate was 98.3% (95% confidence interval: 97.2% to 99.5%). There was no statistical difference in outcomes between protocols ≤ 2 hours and > 2 hours in duration (96.3[92.3 to 100.3]% vs 97.2 [94.6 to 99.8]%; p = 0.71).
- Protocols with > 6 dose escalations were associated with higher success rates compared to those with ≤ 6 doses (99.2[97.9 to 100.4]% vs 95.4[93 to 97.8]%; p = 0.007).
- Zero hypersensitivity adverse events were reported at follow-up between 1 and 46 months. Consequently, no ASA discontinuations were related to hypersensitivity adverse events
According to the study, protocols with > 6 dose escalations may be optimal for ASA desensitization in ACS patients.
(Source: Uptodate; Am J Cardiol. 2019 Jul 1;124(1):14-19)