PDF(Pubmed)
Abstract：
Aspirin hypersensitivity continues to be a major clinical challenge in patients with coronary artery disease (CAD), particularly in those requiring percutaneous coronary intervention (PCI) in the absence of a validated alternative antiplatelet regimen. Although true aspirin allergies are uncommon, they can manifest with severe reactions such as angioedema or anaphylaxis, highlighting the critical role of diagnostic challenge tests and tolerance induction strategies. Here, a 61-year-old female with end-stage renal disease (ESRD) on hemodialysis presented with new-onset heart failure and elevated troponins in the setting of a hypertensive emergency. A subsequent left heart catheterization revealed severe multivessel disease, but PCI was deferred due to her history suggestive of aspirin-induced angioedema and the absence of a known optimal approach in this scenario. Given the feasibility of completing a desensitization protocol, aspirin desensitization was pursued, facilitating the successful placement of a drug-eluting stent. This case highlights the need for validated protocols to manage aspirin hypersensitivity, as the current treatment paradigm necessitates a highly individualized approach by the treating clinician.
摘要：
阿司匹林超敏反应仍然是冠状动脉疾病（CAD）患者的主要临床挑战，特别是在没有经过验证的替代抗血小板方案的情况下需要经皮冠状动脉介入治疗（PCI）的患者中。虽然真正的阿司匹林过敏并不常见，它们可以表现为严重的反应，如血管性水肿或过敏反应，强调诊断挑战测试和耐受性诱导策略的关键作用。这里,一名61岁女性患者,在血液透析中患有终末期肾病(ESRD),在高血压急症中出现新发心力衰竭和肌钙蛋白升高.随后的左心导管检查显示严重的多支血管疾病，但PCI被推迟,因为她的病史提示阿司匹林诱导的血管性水肿,并且在这种情况下没有已知的最佳治疗方法.鉴于完成脱敏方案的可行性，追求阿司匹林脱敏，促进药物洗脱支架的成功放置。这个案例强调了需要经过验证的方案来管理阿司匹林超敏反应，因为当前的治疗模式需要治疗临床医生采取高度个性化的方法。
