Aspirin Desensitisation Protocol for use within Adult Cardiology

Publication: 30/11/2017  --
Last review: 01/01/1900  
Next review: 01/11/2020  
Clinical Protocol
CURRENT 
ID: 5259 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Aspirin Desensitisation Protocol for use within Adult Cardiology

Background and indications for standard operating procedure/protocol
Procedure method (step by step)
Aspirin Desensitisation Chart
Aspirin Desensitisation Patient Information Leaflet

Background and indications for standard operating procedure/protocol

This protocol is NOT suitable for patients with a previous history of bronchospasm or anaphylaxis to aspirin or any of its excipients

Aspirin is indicated in the treatment of coronary artery disease and many other cardiac disorders.  There are some patients who are unable to receive treatment with aspirin due to a previous history of an adverse reaction to aspirin or non-steroidal anti-inflammatory drugs.

Aspirin desensitisation has been successfully used to overcome this problem and is used within many centres within the UK.  This procedure sets of the process for desensitisation of cardiology patients at the Leeds Teaching Hospitals Trust.

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Procedure method (step by step)

Important Notes:

  • Patients will be admitted to the Coronary Care Unit (CCU) or other ward environment with appropriate nursing cover and monitoring for this procedure.
  • The patient should be advised to omit the following medications for the 24 hours before the desensitisation procedure:
    • Anticholinergics
    • Antihistamines
    • Cromoglycate
    • Beta-blockers
    • Angiotensin converting enzyme inhibitors
      If any of the medications are unable to be omitted please discuss with the Immunology Department prior to booking the patient for desensitisation.
    • If a patient is taking anti-leuokotriene medication such as Montelukast bronchospasmic responses to oral aspirin may be blocked but exacerbation of respiratory disease should not be.
    • This protocol must be used alongside the ‘Aspirin Desensitisation Chart’ where all observations and aspirin administrations should be recorded. The protocol should be read in full before the desensitisation is started.
    • The procedure should be stopped if any of the following occur:
      • >10% reduction in peak flow
      • Significant drop in blood pressure or oxygen saturation
      • Any signs of adverse reaction
    • If a patient misses more than 2 doses (>48hours from last dose) then repeat desensitisation will be required.

Procedure:

  1. The patient should have intravenous access available prior to the start of the procedure.
  2. Perform baseline monitoring of blood pressure, oxygen saturations and peak flow and record this on the ‘Aspirin Desensitisation Chart
  3. Prepare ‘Solution A’ by dissolving 1 x 75mg tablet in 75ml water (1mg/ml suspension).
  4. With a 15 minute interval in-between each dose, administer steps 1 to 4 of the desensitisation protocol (see table below).
    1. Prior to each step repeat blood pressure, oxygen saturations and peak flow should be performed.
    2. If there is any alteration in the patient’s condition or monitoring it should be brought to the immediate attention of the doctors.
    3. The time of administration of each dose should be recorded on the chart
  5. Prepare ‘Solution B’ by dissolving 2 x 75mg tablets in 15ml water (10mg/ml suspension)
  6. With a 15 minute interval in-between each dose, administer steps 5 to 7 of the desensitisation protocol (see table below).
    1. Prior to each step repeat blood pressure, oxygen saturations and peak flow should be performed.
    2. If there is any alteration in the patient’s condition or monitoring it should be brought to the immediate attention of the doctors.
    3. The time of administration of each dose should be recorded on the chart.
  7. 15 minutes after step 7 the patient should receive 1 x 75mg tablet. Prior to this repeat blood pressure, oxygen saturations and peak flow should be performed. The time of administration of each dose should be recorded on the chart.
  8. The patient should remain on the ward overnight with regular monitoring.  If there has been no adverse reaction the patient should receive an additional 75mg dose the following morning and be observed for 1 hour before being discharged.
  9. Prior to discharge: the ‘Aspirin Desensitisation Patient Information Leaflet’ should be given to the patient and the importance of not missing doses explained to the patient. The patient should also be discharged with one month’s supply of aspirin 75mg tablets. It should be clearly document on the discharge summary that the patient has been desensitised to aspirin and for their GP allergy record to be updated accordingly.

Step

Dose of Aspirin
(mg)

No of 75mg Tablets

Volume of Water for Suspension

Suspension

Concentration

Volume of Suspension to Administer

1

0.1

1

75ml

1mg/ml

0.1ml

2

0.3

1

75ml

1mg/ml

0.3ml

3

1

1

75ml

1mg/ml

1ml

4

3

1

75ml

1mg/ml

3ml

5

10

2

15ml

10mg/ml

1ml

6

30

2

15ml

10mg/ml

3ml

7

40

2

15ml

10mg/ml

4ml

8

75

1

N/A

N/A

N/A

Solution A: Dissolve 1 x 75mg tablet in 75ml water (1mg/ml suspension)

Solution B: Dissolve 2 x 75mg tablets in 15ml water (10mg/ml suspension)

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Provenance

Record: 5259
Objective:

To ensure the safe and successful desensitisation to aspirin within the Cardiology department in patients who require long-term treatment with aspirin.

Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

  • Chapman A, Rushworth GF & Leslie SJ (2013). Aspirin desensitization in patients undergoing percutaneous coronary intervention: A survey of current practice.  Cardiology Journal; 20(2): 134-138.
  • Wong et al (2000). Rapid oral challenge-desensitisation for patients with aspirin-related urticarial-angioedema.  Journal of Allergy and Clinical Immunology; 105(5): 997-1001.

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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