Tuesday, June 13, 2006

Plavix Allergy

Clorpidogrel ( Plavix ), is a very good friend of interventional cardiologist. It is an ADP receptor blocking agent on the platelet wall. It is a very potent and reliable anti-platelet agent, or so we thought. When we first began to use plavix some 5-6 years ago, we were told that it is very safe, with very few serious side effect, especially when compared to aspirin and ticlopidine.. Because of all these advantages, we have become so use to and in many ways dependent on plavix. This is true the world over, except in Japan, where plavix is yet to be approved. The increasing popularity of Drug-eluting stents, and the impressive results of plavix in the medical management of acute coronary syndrome, had established firmly the role of plavix in the management of CAD.Well like real life, all good things must come to an end. Recently, we are seeing more and more reports of plavix resisitance. We are also hearing rumblings of the introduction of a plavix competitor, parusugrel. We now know that there is a 1-2% incidence of plavix allergy in patients on plavix following drug-eluting stent implantation. In the just completed Annual Scientific Meeting of the American Society of Coronary angiography and interventions in Chicago, there was an abstract presented on desensitisation techniques in 8 patients who had plavix allergy, but who needed plavix The eight patients were successfully desensitised, and had the plavix following drug-eluting stent implantation, without any untoward incidence. This is certainly a useful trick to remember in those of us doing interventions. We all know the consequences of having to stop plavix prematurely. Late stent thrombosis can kill.

No comments: