Induction of Tolerance to Clopidogrel in a Patient with Ischemic Cardiopathy

Abstract

Patients with acute coronary syndrome (ACS) that are admitted in the emergency room are treated with AAS and a loading dose of clopidogrel (300-600 mg) unless contraindicated. A 47 year old male was admitted in the cardiology ward with the diagnosis of ACS. He was revascularized with two drug eluting stents. A loading dose of 300 mg of clopidogrel was used and a 12 months period with dual antiplatelet therapy was recommended (AAS 100 mg plus clopidogrel 75 mg per day). After seven days taking clopidogrel and AAS, the patient presented non-immediate erythematous, pruritic, maculopapular rash. He tolerated AAS after skin reaction. The patient was referred to our department by the cardiology service to perform an induction of tolerance to clopidogrel. There are several, outpatient and inpatient, protocols of desensitization to clopidogrel usually in one day, all of them with good results. To allow hypersensitivity symptoms to resolve before performing desensitization, these protocols require a drug washout period during which time patients are at risk for stent thrombosis while clopidogrel is withheld. We present a method for induction tolerance in a patient with probably hypersensitivity to clopidogrel who has discontinued the medication. The induction of tolerance to clopidogrel has allowed the patient to continue taking this medication necessary for his health in a quickly and safely way.