{
  "abstract": "Background G6PD deficiency is a common inherited enzymatic defect affecting millions globally. The safety of aspirin for G6PD deficiency patients remains a controversial topic. There is a dearth of literature in this area, making it difficult to make decisions. This report presents a case of a patient with ST-segment-elevation myocardial infarction (STEMI) who received aspirin after undergoing PCI. We aim to present a case regarding the safety of aspirin for G6PD deficiency patients looking into critical insights into aspirin administration in such cases.Case Report A 40-year-old woman with a history of G6PD deficiency, hypertension, and chronic anaemia presented with chest pain, which was confirmed to be an inferior ST-segment elevation myocardial infarction (STEMI). She was immediately taken to the catheterization lab for primary percutaneous coronary intervention where a drug-coated balloon was used to treat the culprit lesion on the distal right coronary artery (RCA) due to the patient‘s G6PD deficiency. The procedure revealed the presence of distal clots in the posterior descending artery (PDA) and left ventricular (LV) branches of the RCA, which were managed with tirofiban. The patient received a loading dose of aspirin, but it was discontinued as a maintenance treatment after consultation with the haematology team.On admission, the patient‘s haemoglobin level was extremely low at 65 gm/l, and required two units of red blood cell (RBC) transfusions. A complete haemolysis screening was conducted to rule out any haemolysis, and the results came back normal. The angiogram was reviewed by cardiologists. It was concluded that the cardiac event was caused by plaque rupture rather than a thrombus. They recommended that the patient receive dual antiplatelet therapy (DAPT) for at least a month since she received a drug-coated balloon (DCB) to RCA. Upon discharge, the patient‘s haemoglobin level had significantly improved to 80. To manage the risk of haemolysis associated with G6PD deficiency and the requirement for Dual Antiplatelet Therapy (DAPT), aspirin was considered as a treatment option after thorough consultation with the patient.The patient underwent weekly haemolysis screening, including tests for LDH, reticulocytes, haptoglobin, split bilirubin, FBC, and DAT(table 1). Despite initial concerns, no signs of haemolysis were observed after the administration of aspirin. The rise in LDH was considered most likely due to the patient‘s STEMI. The LDH level subsequently decreased further reinforcing the decision to include aspirin.Abstract 2-038 Table 1Investigations results from admission until follow up On admission On discharge Follow up in 4 weeks Hb (115–165 g/l)659080LDH (125–220 U/l)619515238Reticulocytes 10–120 10*9/l 8375Bilirubin (total/conjugated) (0–20 umol/l)20/513/411/-DATnegativenegative Haptoglobin (0.35–2.5 g/l)2.292.482.59Conclusion DAPT is considered essential following PCI. The use of antiplatelet therapy in CAD and G6PD deficiency patients lacks larger studies, making it difficult to use aspirin in these patients. However, there is growing evidence of aspirin’s feasibility and safety in G6PD deficiency patients. A multi-disciplinary team approach is recommended for decision-making. Further studies are required to understand the safety and efficacy of antiplatelet therapy in G6PD patients.",
  "authors": [
    {
      "affiliations": [
        "Frimley Health NHS Foundation Trust"
      ],
      "name": "Usman Saleem"
    },
    {
      "affiliations": [
        "Frimley Health NHS Foundation Trust"
      ],
      "name": "Mostafa Abdulaziz"
    },
    {
      "affiliations": [
        "Frimley Health NHS Foundation Trust"
      ],
      "name": "Ali Abdulaziz"
    },
    {
      "affiliations": [
        "Manchester University Foundation Trust"
      ],
      "name": "Adeel Hamad"
    }
  ],
  "title": "2-038 Dilemma of aspirin use in coronary vessel disease in G6PD: an interesting case report and consideration in practice",
  "uid": "23bcaca0-5912-5a47-8d9e-d17d46eeef30"
}