Aspirin desensitization in patients undergoing percutaneous coronary intervention: A survey of current practice

Abstract

Background: Aspirin remains the mainstay of anti-platelet therapy in cardiac patients.
However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated — such
as with percutaneous coronary intervention (PCI), then there is no clear guidance. One
possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of
patients with aspirin allergy. The aim of this survey was to assess current knowledge and
practice regarding aspirin desensitization in the UK.

Methods and results: We conducted a UK wide survey of all UK 116 PCI centers and
obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had
previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol
prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization.
Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%)
units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher
doses of thienopyridine class drugs.

Conclusions: In the UK, there appears to be no consistent approach to patients with aspirin
allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin),
and aspirin desensitization in those with known allergy may facilitate this. Sustained effort
should be placed on encouraging UK centers to use desensitization as a treatment modality
prior to PCI rather than avoiding aspirin altogether.