Abstract 4304: Aspirin Intolerance in Patients With Obstructive Coronary Artery Disease: Is Percutaneous Coronary Intervention With Stent Implantation Contra-Indicated?
Background: Dual antiplatelet therapy (i.e. aspirin + thienopyridine) is mandatory after stent implantation and has been shown to reduce the risk of stent thrombosis (ST) and myocardial infarction (MI). Allergy or intolerance to aspirin is often considered a contra-indication to stent implantation, especially with drug-eluting stents (DES). A possible option in some patients is desensitization but data regarding alternative antiplatelet therapy are lacking.
Methods: Retrospective cohort analysis of consecutive patients with adverse reactions to aspirin who received an alternative combination of dual antiplatelet therapy (Indobufen, Trapidil, or Triflusal in association with a thienopyridine) after elective implantation of either DES or bare-metal stents (BMS). Endpoint analyzed were cardiac death, MI, ST and bleeding.
Results: A total of 127 pts, aged 66±9 years, were identified between June’99 and November’08. Majority were male (80.3%) with a previous history of CABG in 31.4%, prior MI in 45.6%, diabetes in 26.7%, and unstable angina at presentation in 24.4%. Reasons for not taking aspirin were gastrointestinal intolerance in 54%, allergic reactions in 39.1%, non-gastrointestinal bleeding in 5.4%, and other in 1.5%. Aspirin was substituted with Indobufen (66.4%), Trapidil (25.8%), Triflusal (6.3%), or a combination of Indobufen+Trapidil (1.5%). Proton pump inhibitors were administered in 77.3%. Patients underwent PCI on 272 lesions with DES in 84% and BMS 16% with implantation of 2.47±2.16 stents and a total median stent length per patient of 38mm (IQR: 20 – 67.5). Majority (81%) of lesions treated were Type B2/C. During a median follow-up of 1055 days (IQR: 566 –1468), there were no cases of definite or probable ST. There were 2 (1.5%) cases of cardiac death: 1 sudden death 436 days after DES implantation and 1 due to heart failure. Cumulative rate of major adverse cardiac events was 23.6%: death 3.9%, MI 0.8%, TVR 22%. Bleeding occurred in 2 (1.5%) patients (1 major and 1 minor).
Conclusions In this small cohort of patients with aspirin intolerance undergoing coronary stent implantation, the combination of a thienopyridine with Indobufen, Trapidil, or Triflusal appears safe and was associated with a low rate of cardiac death, ST and MI.