Aspirin Therapy in Cardiovascular Disease with Glucose-6-Phosphate Dehydrogenase Deficiency, Safe or Not?
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CURRENT OPINION
Aspirin Therapy in Cardiovascular Disease with Glucose‑6‑Phosphate Dehydrogenase Deficiency, Safe or Not? Jianle Li1 · Yicong Chen1 · Zilin Ou1 · Fubing Ouyang1 · Jiahui Liang1 · Zimu Jiang1 · Chunyong Chen1 · Pingping Li1 · Jiaxin Chen1 · Jiating Wei1 · Jinsheng Zeng1 Accepted: 20 November 2020 © Springer Nature Switzerland AG 2020
Abstract Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect, which may present as acute hemolysis, neonatal jaundice, or chronic hemolysis. Ingestion of fava beans, as well as infection and certain drugs, are the most typical causes of acute hemolysis in people with G6PD deficiency. Aspirin, the cornerstone in current therapies for the prevention of cardiovascular disease (CVD), is occasionally reported to induce acute hemolysis in G6PD-deficient individuals. G6PD deficiency is typically asymptomatic and many CVD patients with this enzyme defect start to take longterm aspirin therapy without G6PD activity examination; however, no consensus on the safety of aspirin in this population has been reached. A few studies have reported on this issue and produced contradictory results. In this review, we discuss the possible mechanisms of aspirin-induced hemolysis, and summarize clinical evidence regarding the safety of aspirin in subjects with G6PD deficiency.
1 Possible Mechanism of Aspirin‑Induced Hemolysis in Glucose‑6‑Phosphate Dehydrogenase (G6PD) Deficiency Acute hemolysis in G6PD deficiency is more common in male subjects, mainly related to less residual enzyme activity [17]. The G6PD gene is located on the X chromosome, hence the illness is inherited in a typical X-linked fashion. Males are hemizygous for the G6PD gene and can therefore have normal gene expression or G6PD deficiency. Females can have normal gene expression or be heterozygous or homozygous, depending on the copies of the mutated gene on the X chromosome [18]. Heterozygous females have two erythrocyte populations—one is
Key Points Hemolysis crisis has occasionally been reported in cardiovascular disease (CVD) patients with glucose6-phosphate dehydrogenase (G6PD) deficiency who are receiving aspirin. Recent studies showed a higher risk of hemoglobin decline, major bleeding, and mortality in CVD patients with G6PD deficiency taking aspirin. The current evidence regarding the safety of aspirin therapy in CVD patients with G6PD deficiency is mainly from a few case reports and small-sample cohort studies, therefore large, randomized, controlled clinical trials are warranted.
Jianle Li and Yicong Chen contributed equally to this study. * Jinsheng Zeng [email protected]; [email protected] 1
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Disea
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