Comparing Allergist And Cardiologist Considerations For The Optimal Management Of Thienopyridines Hypersensitivity

The thienopyridine family includes ticlopidine, clopidogrel and prasugrel which are antiplatelet drugs largely used, mainly associated to aspirin, for treatment of acute coronary syndromes and after percutaneous coronary interventions, to avoid thrombosis. In some patients, thienpyridines may cause hypersensitivity reactions which jeopardize the optimal therapeutic and preventive approach to vascular diseases. The management of thienopyridine hypersensitivity is best done as an interdisciplinary collaboration between the allergist and cardiologist. For the cardiologist, the important issues are the necessity of continuing therapy, the desired duration of therapy based on the clinical indication of the individual patient and appropiateness of using one of the alternative P2Y12 inhibitors. For the allergist, the important issues are weighing the risk and benefits of the various therapeutic options: treating "through" desensitization or switching to an alternative agent. Working togetther, a cardio-allergy team of specialists may offer the best approach to clinical decision making for the indivual paient.