Acetylsalicylic acid desensitization in patients with coronary artery disease: A comprehensive overview of currently available protocols

Background: Acetylsalicylic acid (ASA) represents the basis of pharmacological therapy for cardiovascular preven- tion. However, several patients are excluded from the benefits of ASA for hypersensitivity problems, and contro- versies still exist on their management. The aim of present study was to evaluate the safety and efficacy of ASA desensitization protocols in patients requiring dual antiplatelet therapy for coronary artery disease. Methods: Literature archives and main scientific sessions' abstracts were scanned for studies describing desensi- tization protocols for patients with ASA hypersensitivity. Primary endpoint was the tolerance of ASA mainte- nance therapy (protocol success). Secondary endpoints were: 1) the occurrence of hypersensitivity symptoms during the protocol, 2) the rate of ASA discontinuation at follow-up; 3) recurrent cardiovascular ischemic events. Results: We finally selected 14 studies out of 335 initially screened citation, reporting complete data on protocol de- sensitization strategies, with a total of 256 patients. Among them 213 (83.2%) underwent an oral desensitization pro- tocol, while 43 received endovenous ASA. The protocol was successfully completed in 238 out of 256 patients (92.9%), who were subsequently kept on chronic daily therapy with ASA. The weighted success proportion was wP [95%CI] = 93[89.8–96.1]%. Hypersensivity symptoms occurred during the desensitization protocol in 29 patients, with a pooled events rate of 11.3[7.5–15.2]%. All adverse reactions were safely faced with pharmacological interventions. In 11 of these patients, slowing the protocol or restarting another ASA challenge could successfully achieve the tolerance. The rate of ASA discontinuation and major cardiovascular events was extremely low (6.1 and 2.3% respectively). Conclusions: Aspirin desensitization protocols represent a safe and effective option for the management of patients with a cardiovascular indication to ASA and history of allergy to ASA. Future randomized trials are certainly needed to con- firm present findings and provide indications for the optimization of these protocols