# Successful Management of Aspirin Intolerance After Ad Hoc PCI: A Case Report and a Developed Algorithm

## TL;DR

A patient with aspirin hypersensitivity successfully underwent PCI after desensitization, but later required alternative antiplatelet therapy when desensitization failed.

## Contribution

A new algorithm is proposed for managing aspirin intolerance after PCI, emphasizing desensitization and alternative therapies.

## Key findings

- Aspirin desensitization allowed initial successful treatment of a patient with coronary stenosis.
- Failure of subsequent desensitization led to effective Ticagrelor monotherapy without complications.
- Aspirin hypersensitivity is underdiagnosed and can be safely managed with desensitization or alternatives.

## Abstract

In managing atherosclerotic cardiovascular disease, especially after percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT), prominently aspirin and a P2Y12 inhibitor, is fundamental. Nonetheless, aspirin hypersensitivity complicates treatment for some patients. Desensitization processes have been identified as a viable method to circumvent this issue. This case report describes a 75‐year‐old man diagnosed with significant stenosis in the coronary artery who was scheduled for elective PCI of the right coronary artery. The patient's medical record noted a hypersensitivity to aspirin. Initially, the patient underwent successful desensitization to aspirin, allowing for treatment with aspirin and Clopidogrel. However, the need for another desensitization emerged months later, which unfortunately was unsuccessful. As a result, the patient's treatment was shifted to Ticagrelor monotherapy, a potent antiplatelet strategy, which was carried out without any complications during the follow‐up period.

Aspirin hypersensitivity occurs in 1%–5% of patients and is often mistaken for intolerance, leading to undertreatment. Desensitization and low‐dose challenges are effective and safe but underutilized for patients needing aspirin despite hypersensitivity. If the desensitization fails, the selection of alternative antithrombotic therapy might be appropriate in selected cases.

Proposed Algorithm for Management of Aspirin Intolerance After PCI.