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Clopidogrel Allergy Can Be Tackled By Methodical Desensitization

A study that is to be presented at the 29th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI) says that following// a methodical desensitization protocol might help patients who are allergic to anti-clotting medication that is vital to prevent the formation of new blockages in coronary stents.

"Allergic reactions can be quite frightening to patients and physicians, and can lead to discontinuation of the medication," said the study's lead author, Nicholas E. Walker, MD, a cardiology fellow at the University of Iowa, Iowa City. "We showed we could successfully and safely desensitize patients who had just recently had a drug-eluting stent placed. That's a critical population to manage."

Perhaps two out of every hundred patients treated with the anti-clotting medication clopidogrel develop an allergic reaction marked by rash, itching, hives, or swelling of the tongue and airway. A small number of patients even develop an anaphylactic reaction and go into shock.

Physicians generally discontinue a medication that provokes an allergic reaction and prescribe an alternative. However, in the case of clopidogrel, substitute medications are either just as likely to provoke allergy symptoms or markedly less effective. Stopping the medication may be riskier than continuing it: Patients who do not take clopidogrel after stenting--particularly after receiving a drug-eluting stent--face approximately three times the risk of a blood clot blocking the stent and causing a heart attack.

"With widespread use of drug-eluting stents, it's going to be more common to see allergic reactions to clopidogrel, and more critical that we find a way to keep patients on the medication," said Phillip A. Horwitz, MD, a professor of medicine and an interventional cardiologist at the University of Iowa Hospitals and Clinics.

Eight patients with clopidogrel hypersensitivity were treated with the des
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