Use of Prasugrel in a Patient with Clopidogrel Hypersensitivity

• Published in: The Annals of pharmacotherapy 2011-10, Vol.45 (10), p.1307-1307
• Main Authors: Peppard, Sarah R, Held-Godgluck, Bethanne M, Beddingfield, Richard
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Aspirin; Drug Hypersensitivity - complications; Humans; Male; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - surgery; Piperazines - therapeutic use; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists - adverse effects; Purinergic P2Y Receptor Antagonists - therapeutic use; Stents - adverse effects; Thiophenes - therapeutic use; Thrombosis - prevention & control; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Treatment Outcome
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1Q287

Objective: To report a case of successful use of prasugrel following percutaneous coronary intervention with placement of a bare metal stent in a patient with a documented hypersensitivity reaction to clopidogrel. Case Summary: A 61-year-old male with a history of coronary artery disease with coronary stent placement presented with ST-elevation myocardial infarction. The patient had developed Stephens-Johnson syndrome 6 years earlier following Clopidogrel administration, characterized by erythematous plaques and subsequent desquamation of the hands and feet; Clopidogrel was discontinued and he was subsequently treated with ticlopidine in addition to aspirin. The third-generation thienopyridine prasugrel was initiated as a therapeutic alternative to Clopidogrel after placement of a bare metal stent; a 60-mg dose was administered after extubation, followed by 10 mg/day. No signs of allergic reaction were observed in the days, weeks, and months following administration. Discussion: Thienopyridines, specifically Clopidogrel, are the standard of care for prevention of coronary stent thrombosis; however, there are few data available on cross-hypersensitivity between these agents. One study demonstrated that 27% of patients who developed an allergic or hematologic reaction to Clopidogrel developed a similar reaction to ticlopidine. Other therapeutic options for patients with Clopidogrel hypersensitivity who are undergoing a percutaneous coronary intervention with stent placement include Clopidogrel desensitization, warfarin plus aspirin, cilostazol, ticagrelor, and ticlopidine. However, these options are limited by efficacy and/or toxicity. With its approval in 2009, prasugrel has become a potential treatment option. Conclusions: Prasugrel may be considered a therapeutic alternative in some patients allergic or intolerant to Clopidogrel, but additional data are warranted to make a strong conclusion.