Successful use of prasugrel, an alternative antiplatelet agent, in a patient with clopidogrel allergy.

摘要

Clopidogrel is a widely used antiplatelet agent indicated for patients who require coronary stent placement. Available data also support its use in secondary prevention of atherothrombotic disease. Clopidogrel is a thienopyridine prodrug that requires bioactiva-tion before it can achieve its antiplatelet effects. It undergoes metabolism using the cytochrome P450 system. The active metabolite of clopidogrel irreversibly inhibits adenosine diphosphate and antagonizes P2Y12, allowing for maximal platelet inhibition and preventing platelet aggregation. Allergic reactions, commonly a rash, have been documented to occur in approximately 1% of patients taking clopidogrel.1 When clopidogrel cannot be used, alternative thienopyridines, such as ticlopidine, are considered. Newer P2Y12 receptor blockers have been developed and include prasugrel and ticagrelor. Currently, there are not enough data on cross-reactivity between these agents.