Aspirin Safety in G6PD Deficient Patients
Low-dose aspirin can be safely administered to patients with G6PD deficiency, as there is sufficient evidence showing no significant risk of hemolysis with therapeutic doses. 1
Safety Profile of Aspirin in G6PD Deficiency
- Contrary to historical concerns, long-term, low-dose aspirin therapy has been demonstrated to be safe in patients with G6PD deficiency, including those with Mediterranean-type G6PD deficiency 1
- A study monitoring 44 patients with Mediterranean-type G6PD deficiency on long-term, low-dose aspirin showed normal complete blood counts, reticulocyte counts, and serum bilirubin levels over a three-month period 1
- More recent evidence supports that aspirin can be safely used in G6PD-deficient patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents as part of dual antiplatelet therapy 2, 3
Clinical Applications and Dosing
- Aspirin can be administered at standard doses of 650-1,000 mg every four to six hours for acute pain management, with a maximum initial dose of 1 g and maximum daily dosage of 4 g 4
- For cardiovascular disease prevention in G6PD-deficient patients, low-dose aspirin (typically 75-100 mg daily) has been used safely without evidence of hemolysis 3
- Dual antiplatelet therapy including aspirin plus ticagrelor has been successfully used in G6PD-deficient patients with non-ST-segment elevation acute coronary syndromes 3
Medications to Avoid in G6PD Deficiency
- While aspirin is safe, several medications are definitively contraindicated in G6PD deficiency due to high risk of hemolysis 5:
Monitoring Recommendations
- Although not necessary for aspirin specifically, when starting any medication in G6PD-deficient patients, monitor for signs of hemolysis such as jaundice, dark urine, fatigue, and pallor 6
- For patients with G6PD deficiency who develop methemoglobinemia, avoid methylene blue treatment as it can worsen the condition; instead, use ascorbic acid (vitamin C) as the treatment of choice 4
- Screening for G6PD deficiency is recommended before starting therapy with known oxidant drugs in patients with predisposing racial or ethnic backgrounds (Mediterranean, African, Indian, or Southeast Asian descent) 6
Special Considerations
- The severity of G6PD deficiency varies based on genetic variant, with the Mediterranean variant (Gdmed) typically causing more severe reactions than the African variant (GdA-) 6
- In cases where methemoglobinemia occurs in G6PD-deficient patients, ascorbic acid is the treatment of choice rather than methylene blue 4
- For patients with G6PD deficiency requiring antimalarial treatment, chloroquine is considered safe and is the preferred first-line treatment for P. malariae or P. knowlesi 4
In conclusion, the historical concern about aspirin causing hemolysis in G6PD-deficient patients is not supported by current evidence. Low-dose aspirin can be safely administered to these patients, particularly for cardiovascular indications, without significant risk of hemolytic complications.