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Management of Antiplatelet Allergy After Cardiac Stenting ONLINE FIRST

Nicole Fett, MD, MSCE1
[+] Author Affiliations
1Department of Dermatology, Oregon Health and Science University, Portland, Oregon
JAMA Dermatol. Published online June 22, 2016. doi:10.1001/jamadermatol.2016.1983
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This case report describes the management of antiplatelet allergy after cardiac stenting.

Clopidogrel is an antiplatelet agent used to prevent in-stent thrombosis after percutaneous coronary intervention (PCI). Discontinuation of clopidogrel therapy within 1 month of PCI results in in-stent thrombosis in more than 25% of patients and is associated with high mortality.1 Up to 6% of patients will develop a clopidogrel allergy but remain dependent on antiplatelet agents to prevent in-stent thrombosis.24 We report a case of generalized bullous fixed drug eruption associated with clopidogrel and review the recommended management strategies for clopidogrel allergy.

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Figure 1.
Clinical Image of Generalized Bullous Fixed Drug Eruption

A violaceous plaque is evident with a central bulla on the right posterior calf.

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Figure 2.
Lesion Biopsy Specimen From a Case of Bullous Fixed Drug Eruption

This image reveals keratinocyte necrosis, basalar liquefaction with interface lymphocytes, and scattered eosinophils (hematoxylin-eosin, original magnification ×10).

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