Cor Vasa 2023, 65(6):874-876 | DOI: 10.33678/cor.2023.028

Aspirin-induced Anaphylactoid Reactions in a Patient with Acute Coronary Syndrome Complicating Acute Lung Edema: a Case Report

Meity Ardiana, Kevin Francio, Inna Maya Sufiyah, Fita Triastuti, Muhammad Nuh Hamdani

Cardiology and Vascular Medicine Department, Medical Faculty of Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia

Background: Antiplatelet therapy is an essential treatment for patients with acute coronary syndrome. But a history of aspirin hypersensitivity has been reported and it might be challenging to treat a patient with this case. Case: A 65-year-old Javanese woman came to the emergency department and presented with dyspnea for three days and with orthopnea. Based on physical and supporting examination, the patient was diagnosed with ADHF. However, on the 3rd day of treatment, ECG showed new T wave inversion at lead V₁ to V₆, I, and aVL lead to NSTEACS. Loading doses of antiplatelets (clopidogrel and aspirin) were administered. Three hours after the drug administration, the patient complained of sudden worsening shortness of breath with pronounced wheezing. Allergic reaction was suspected and due to the patient's history of multiple NSAIDs allergies, aspirin was suspected as the culprit.

Discussion: Aspirin as a COX-1 inhibitor, is often implicated with hypersensitivity reactions. Using a more potent P2Y₁₂ receptor antagonist and performing rapid oral desensitization once the patient has stabilized is a strategy in this kind of case.

Keywords: Acute coronary syndrome, Anaphylaxis, Aspirin, Hypersensitivity

Received: March 4, 2023; Revised: March 4, 2023; Accepted: March 26, 2023; Prepublished online: December 7, 2023; Published: December 22, 2023  Show citation