Reactions 1420 - 22 Sep 2012

SPrasugrel

Hypersensitivity: case reportA 40-year-old woman developed a hypersensitivity

reaction during treatment with prasugrel.The woman received a stent and initially received

antiplatelet therapy with aspirin and clopidogrel. However,she developed acute thrombosis of the stent andclopidogrel was replaced with prasugrel [route andduration of treatment to reaction onset not stated] at aninitial loading dose of 60mg, followed by 10 mg/day.Abciximab was also added. She required intubation andventilation and haemodynamic support. She wastransferred to another centre. On admission, her bodytemperature was 38.1°C. Laboratory tests revealed thefollowing: leucocytes 7.23 x 109/L (eosinophils 2.4%), AST208 UI/L, ALT 93 UI/L, GGT 240 UI/L, and ALP 170 UI/L. Shereceived levosimendan and her haemodynamic situationprogressively stabilised and she was extubated. Her liverfunction tests showed transient improvement. She wastreated with antibiotics but her fever continued over thenext few days. Antipyretics provided transitory remission.After 12 days, she had more frequent bowel movements.On day 23 after her admission, tests showed the following:AST 115 UI/L, ALT 155 UI/L, GGT 723 UI/L, and relativeeosinophilia appeared. A drug-induced hypersensitivityreaction was suspected.

The woman’s prasugrel was suspended and she receivedclopidogrel instead. In the first 24 hours after this change,her fever and diarrhoea went into remission. Her liverfunction tests and leucocyte differentials progressivelynormalised. She presented a second episode of low cardiacoutput after 7 days and received vasoactive drugs. She hadno abnormal laboratory results nor fever. She eventuallyreceived a heart transplant and the follow-up showed noreappearance of symptoms.

Author comment: [T]he implication of [prasugrel] as thecause is ‘probable’ according to the Maria and Victorino scale(16 points).Fernandez-Ruiz M, et al. Management of a hypersensitivity reaction tothienopyridines: Prasugrel-induced fever and hepatitis resolved after switching toclopidogrel. Revista Espanola de Cardiologia 65: 773-774, No. 8, Aug 2012.Available from: URL: http://dx.doi.org/10.1016/j.recesp.2011.11.011 [Spanish;summarised from a translation] - Spain 803077387

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Reactions 22 Sep 2012 No. 14200114-9954/10/1420-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved