Treatment helps heart attack patient with reaction tolerate aspirin
Case report shows aspirin possible with drug-induced nonallergic angioedema
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People with drug-induced nonallergic angioedema caused by aspirin who have had a heart attack may still be able to receive aspirin after undergoing desensitization soon after emergency treatment, a case report from France showed.
Aspirin desensitization involves giving gradually increasing aspirin doses under close medical supervision until the patient can tolerate the medication. Aspirin is an important part of treatment after a heart attack and stent placement because it helps prevent the formation of blood clots that could block the artery or the stent.
“This case highlights the feasibility and safety of early desensitization, allowing timely initiation of guideline‐recommended” therapy, the authors wrote.
The case report, “STEMI in a Patient With Aspirin-Induced Angioedema: A Case for Early Desensitization,” was published in Catheterization and Cardiovascular Interventions.
Angioedema is marked by rapid swelling beneath the skin or mucous membranes, often affecting the face, lips, tongue, or throat. It can be triggered by medications, including aspirin.
Aspirin key to heart treatment
Aspirin plays a central role in treating acute heart syndromes, a group of conditions caused by a sudden reduction in blood flow to the heart. In people with ST-segment elevation myocardial infarction (STEMI), the most severe type of heart attack, aspirin is usually given together with other medications to help prevent blood clots from forming inside a newly placed coronary stent.
But for people with aspirin hypersensitivity, including aspirin-induced angioedema, using the drug can trigger potentially serious reactions, making treatment decisions more challenging.
This case report describes a 47-year-old man with a family history of heart disease. He had had aspirin-induced angioedema since age 12, although he had never undergone allergy testing.
The man sought emergency medical care about two hours after developing chest pain that spread to his jaw and caused nausea. Doctors diagnosed him with an inferior STEMI, a life-threatening condition caused by a total blockage of blood flow supplying the lower part of the heart.
Since aspirin was not an option, doctors gave the man ticagrelor, an oral medication that helps prevent blood clots, along with heparin, a blood thinner that reduces the blood’s ability to clot.
He was also given intravenous tirofiban before undergoing emergency percutaneous coronary intervention, a procedure in which a blocked coronary artery is reopened and a stent is inserted to restore blood flow. The procedure successfully reopened the blocked artery.
While waiting to perform aspirin desensitization, physicians continued an intensified regimen to reduce the risk of blood clots forming in the stent.
About 36 hours after the stent procedure, the man underwent a rapid aspirin desensitization protocol in a monitored coronary care unit.
Doctors administered gradually increasing aspirin doses — from 5 mg to 75 mg — over two hours while continuously monitoring his heart rhythm and symptoms. He completed the protocol without developing an allergic reaction and began taking 75 mg of aspirin daily as part of guideline-recommended dual antiplatelet therapy.
The man later underwent planned treatment for additional narrowed heart arteries and completed cardiac rehabilitation. He was symptom-free three months later. His heart’s pumping ability improved from 47% shortly after the heart attack to 53% at follow-up.
The case highlights how “early aspirin desensitization (24–48 h) is a feasible and safe strategy in STEMI patients with aspirin hypersensitivity, allowing patients to receive recommended treatment after emergency coronary intervention,” the authors concluded.
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