Drug-eluting stents in a patient with favism: is the aspirin administration safe?

Abstract

We describe the case of a 64-year-old patient with glucose-6-phosphate dehydrogenase deficiency who was referred to our hospital because of an acute inferior myocardial infarction.Given the possible risk of acute haemolytic anaemia, aspirin was not given in the acute phase, and the patient was successfully treated by balloon angioplasty of the right coronary artery.After functional and genetic testing showing the presence of the Mediterranean mutation, known to be a class II variant, the patient received oral daily aspirin (100 mg) under strict monitoring in order to promptly detect any sign of haemolysis. After 4 days, a complex percutaneous coronary intervention with an implantation of two drug-eluting stents was successfully performed on the left coronary artery. After 3 months, the patient is free from adverse events.Glucose-6-phosphate dehydrogenase deficiency is commonly considered a contraindication to aspirin intake; however, this case shows that aspirin at low, antiplatelet dosage is well tolerated and should not be denied to patients with ischaemic heart disease and complex coronary anatomy.

Antiplatelet and invasive treatment in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency and acute coronary syndrome. The safety of aspirin

“…There are only a few reports on the long‐term safety of ASA in patients with favism . Moreover, reports are even fewer regarding the long‐term safety and efficacy of DAPT in patients with G6PD deficiency needing PCI with DES, and thus, no official guidelines are available …”

“…11 Moreover, reports are even fewer regarding the long-term safety and efficacy of DAPT in patients with G6PD deficiency needing PCI with DES, and thus, no official guidelines are available. 12,13 The limited data available on the safety of ASA in patients with favism and ACS are rather contradictory. Porto et al 12 describe a case of anterior STEMI treated in the acute phase using manual thrombectomy and intracoronary IIb/IIIa glycoprotein inhibition with abciximab without any attempt to implant a stent.…”

“…Seven days later, a repeat angiography showed a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow and the presence of an intermediate proximal LAD lesion which was not treated due to the existing history of G6PD deficiency and 'loss of consciousness' at a younger age after taking aspirin. Rigattieri et al 13 describe a case of acute inferior myocardial infarction in a patient with G6PD deficiency. Aspirin was not given in the acute phase, and the patient was successfully treated with balloon angioplasty of the right coronary artery.…”

Pharmacological and dietary prevention for colorectal cancer

“…Because of his already mentioned antiplatelet effect, the use of aspirin in association with other drugs that increase the risk of bleeding must be controlled. In addition, aspirin should be used with prudence in the elderly, because of the risk of Reye's syndrome [18] and in individuals with favism, although recent studies have shown a good tolerance to low doses of the drug in these patients [19]. …”

Glucose-6-Phosphate Dehydrogenase (G6PDH) Deficiency in a Patient with ST-Segment Elevation Acute Myocardial Infarction Successfully Treated by Simple Thrombectomy

“…To the best of our knowledge, there is only one other report about STEMI in patients with favism, by Rigattieri et al 23) . The incidence of cadiovascular disease in patients with favism seems to be low, and the cardiovascular protective role of this genetic alteration has been hypothesized 24) .…”