From the Guidelines
If you are allergic to Brilinta, you should not assume it is safe to take aspirin without consulting your healthcare provider first, as the decision to take aspirin depends on the nature and severity of your Brilinta allergy. The 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction recommends aspirin for patients as soon as possible after hospital presentation and continued indefinitely in patients who tolerate it 1. However, for patients who are unable to take aspirin due to hypersensitivity, a loading dose followed by a daily maintenance dose of either clopidogrel, prasugrel, or ticagrelor should be administered 1.
When considering aspirin for a patient allergic to Brilinta, it's crucial to understand that while these medications belong to different classes, the allergy could potentially influence the choice of antiplatelet therapy. The guidelines suggest that for patients with a definite UA/NSTEMI at medium or high risk, dual antiplatelet therapy should be initiated, with aspirin being one of the components, unless there's a specific reason, like hypersensitivity, to avoid it 1.
Key considerations include:
- The nature of the Brilinta allergy: Was it a mild reaction or a severe anaphylactic response?
- The presence of any other medical conditions that could affect the choice of antiplatelet therapy.
- The potential for cross-reactivity, although Brilinta and aspirin work through different mechanisms.
Given these considerations, the safest approach is to consult with a healthcare provider who can assess the individual's specific situation and make an informed decision about the use of aspirin or alternative antiplatelet medications. This might include clopidogrel, which is recommended as an alternative in patients who cannot take aspirin due to hypersensitivity 1. Ultimately, the goal is to balance the risk of bleeding against the need to prevent thrombotic events, and this requires personalized medical guidance.
From the Research
Allergic Reaction to Brilinta and Aspirin Use
- There are no direct studies comparing the use of aspirin in patients allergic to Brilinta (ticagrelor) in the provided evidence.
- However, the studies suggest that ticagrelor is often used in combination with aspirin for patients with acute coronary syndrome or minor ischemic stroke/transient ischemic attack 2, 3, 4.
- The combination of ticagrelor and aspirin has been shown to be effective in preventing recurrent strokes or death, but it also increases the risk of bleeding 2, 4.
- If a patient is allergic to Brilinta, it is essential to consider alternative antiplatelet therapies, such as clopidogrel or prasugrel, which can be used in combination with aspirin 3, 5, 6.
- The choice of antiplatelet agent should be made on an individual patient basis, taking into account the patient's medical history, risk factors, and potential side effects 3, 5.