Aspirin for G6PD Deficient Patients May Deserve a Second Look

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A study presented today at the 2020 International Stroke Conference in Los Angeles finds that the long-term use of low-dose aspirin in ischemic stroke patients who have a glucose-6-phosphate dehydrogenase (G6PD) deficiency, may have higher risks of moderate-to-severe bleeding and all-cause death.

The study was featured in a poster presentation today by Yicong Chen, et al., of Sun Yat-sen University in China.

G6PD is an inherited condition in which red blood cells break down in response to certain triggers, such as infection, stress, certain drugs or specific foods, such as fava beans. It can lead to fever, dark urine, abdominal and back pain, fatigue, and pale skin.

In this study, researchers evaluated the use of aspirin in G6PD patients who had a stroke and received aspirin, which is a common antiplatelet therapy to prevent secondary stroke. Their question:  Does aspirin increase the risk of hemolysis, bleeding or death in patients with G6PD deficiency?

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In this prospective, multicenter, observational study, they compared the safety and efficacy of long-term low-dose aspirin in ischemic stroke patients with and without G6PD deficiency.

Patients with and without G6PD deficiency were given low-dose aspirin of 100 mg/daily for three months. G6PD levels were examined after stroke occurrence.

Of 1,121 patients, 130 (11.6%) were G6PD-deficient and 991 (88.4%) were G6PD-normal. 81 G6PD-deficient patients and 576 G6PD-normal patients received low-dose aspirin for three months.

One G6PD-deficient patient experienced acute hemolysis, but in none of the G6PD-normal patients. Moderate-to-severe bleeding occurred in 2.5% of deficient patients and 0.3% normal patients. And, the all-cause death rate as 6.2% in deficient patients and 1.4% in normal patients. Stroke affected 2.5% of deficient patients and 1.7% of normal patients.G6PD deficiency was associated with increased moderate-to-severe bleeding (P = 0.048) and all-cause death during aspirin use (P = 0.008).

The researchers concluded that G6PD deficient stroke patients treated with low-dose aspirin were at higher risk of moderate to severe bleeding, but also all-cause death. However, stroke recurrence rates were similar among the two groups.

REFERENCE

Yicong Chen, Jinsheng Zeng. "Safety and Efficacy of Long-term Low-dose Aspirin in Ischemic Stroke Patients With Glucose-6-phosphate Dehydrogenase Deficiency." International Stroke Conference. Feb. 19, 2020. Abstract: LBP19