Using alternative antiplatelet drugs in patients intolerant to aspirin after stenting

This study investigated whether patients with aspirin intolerance could receive an alternative antiplatelet medication after coronary angioplasty with stenting.

Patients who undergo a stenting procedure to dilate the blood vessels leading to the heart (coronary arteries) need to take drugs that prevent blood clots from forming. Such drugs are termed antiplatelet drugs and include aspirin and many others. Patients who received stenting (placement of a mesh tube inside the narrowed coronary artery) typically receive a combination of two antiplatelet drugs: aspirin and clopidogrel (Plavix). Unfortunately, some people cannot tolerate or are allergic to aspirin and may not be able to benefit from stenting.

This study investigated the use of alternative antiplatelet drugs in 127 patients intolerant to aspirin. These patients were treated with indobufen (Ibustrin) , trapidil (Travisco) or triflusal (Disgren) instead of aspirin following a stenting procedure. Most patients also received clopidogrel. Reasons why aspirin was not tolerated included bleeding from intestinal or stomach ulcers, allergic skin reactions and asthma attacks. Results showed that 1 year after the procedure there were no occurrences of heart attacks outside the hospital. There was a single case of stent blockage after stopping the antiplatelet therapy.

Results showed that the three antiplatelet drugs investigated were effective at preventing cardiovascular events and stent blockage in patients with aspirin intolerance.

This was a rather small study that did not directly compare aspirin to the alternative antiplatelet drugs. Patients with intolerance to aspirin may benefit from stenting, but larger trials are needed to determine if using alternative drugs is indeed safe.

If you have intolerance to aspirin and are considering angioplasty with stenting, you should thoroughly discuss treatment options with your doctor.