Managing Favism in Patients with Heart Stents: Medication Concerns

Q: Managing Favism in Patients with Heart Stents: Medication Concerns

Hello： Patients with G6PD deficiency typically do not exhibit symptoms. <br>However, due to the abnormality of the G6PD enzyme in red blood cells, exposure to or consumption of certain substances (such as fava beans, camphor, gentian violet, sulfonamides, etc.) can lead to hemoly

Favism and Berkey enteric-coated capsules?

The patient has favism and underwent coronary stenting due to a myocardial infarction.
After the procedure, a prescription for Beraprost sodium enteric-coated microparticles was issued; however, some hospitals have contraindications for this medication in patients with favism.
Can the patient continue to take this medication? Are there alternative medications available? The patient frequently experiences chest tightness, difficulty breathing, and back pain.

Cai Xiansheng, 40~49 year old female. Ask Date: 2021/10/10

Dr. Huang Yinghe reply Cardiology

Hello: Patients with G6PD deficiency typically do not exhibit symptoms.
However, due to the abnormality of the G6PD enzyme in red blood cells, exposure to or consumption of certain substances (such as fava beans, camphor, gentian violet, sulfonamides, etc.) can lead to hemolysis, or the rupture of red blood cells.
The World Health Organization classifies G6PD deficiency into five genotypic variants.
There have been reports in the literature indicating that aspirin can cause hemolytic symptoms in G6PD-deficient patients, but this is more commonly seen in patients with the severe enzyme deficiency of the first variant.
The other variants (two to five) can generally be used safely under monitoring.
Currently, G6PD genotyping is not a routine diagnostic procedure, and most patients are unaware of their specific genotype.
Aspirin is also a fundamental treatment for coronary artery disease, and after the placement of a cardiac stent, it is necessary to use aspirin along with another antiplatelet medication to prevent acute stent thrombosis, which can be immediately life-threatening.
Therefore, G6PD-deficient patients should avoid stent placement unless absolutely necessary.
However, in cases of myocardial infarction, stent placement is essential, and both aspirin and another antiplatelet medication must be taken while monitoring for signs of hemolysis, such as jaundice, pallor, or dark urine.
If hemolytic symptoms occur, immediate medical attention is required.
If hemolysis does occur, the alternative is to use only the other antiplatelet medication (Clopidogrel), but this increases the risk of thrombosis.
This presents a challenging clinical dilemma, and there may not be a standard answer.
If there are concerns, it is advisable to discuss them with the patient's physician.

Reply Date: 2021/10/10

More Info

Managing patients with heart stents who also have favism (a condition that causes hemolytic anemia in response to fava beans and certain medications) requires careful consideration of medication interactions and potential risks. In your case, the concern arises from the prescription of Berkey enteric-coated capsules, which may have contraindications in patients with favism.

Favism is primarily associated with a deficiency in the enzyme glucose-6-phosphate dehydrogenase (G6PD). Individuals with this deficiency can experience hemolytic anemia when exposed to certain triggers, including fava beans and specific medications. It is crucial to identify any medications that may exacerbate this condition.

In the context of your heart condition and the placement of a stent, the primary goal is to ensure that you are on an effective regimen to prevent thrombus formation while minimizing the risk of hemolytic reactions. If the medication prescribed is contraindicated for patients with favism, it is essential to discuss this with your healthcare provider. They may consider alternative medications that are safer for individuals with G6PD deficiency.

Common medications used in patients with heart stents include antiplatelet agents like aspirin and clopidogrel. These medications are crucial for preventing clot formation and ensuring the longevity of the stent. However, some medications, particularly certain antibiotics, antimalarials, and non-steroidal anti-inflammatory drugs (NSAIDs), can trigger hemolysis in G6PD-deficient patients.

Given your symptoms of chest tightness, difficulty breathing, and back pain, it is vital to address these concerns while managing your medication regimen. If you are experiencing these symptoms, it may indicate that your current treatment plan needs to be reassessed. It is essential to communicate these symptoms to your healthcare provider, as they may require further evaluation to rule out complications related to your heart condition or the effects of your medications.

In terms of alternatives, if Berkey enteric-coated capsules are contraindicated, your doctor may consider other medications that do not pose a risk for hemolysis. Some potential alternatives could include other classes of medications that are effective for managing your heart condition without the same risks. For instance, if the medication is intended for gastrointestinal issues, alternatives such as proton pump inhibitors or other classes of medications may be considered, depending on your specific needs.

Ultimately, the management of your condition should be a collaborative effort between you and your healthcare provider. It is crucial to have an open dialogue about your concerns regarding favism and the medications prescribed. Your healthcare provider can perform a thorough review of your medications, assess the risks and benefits, and make necessary adjustments to ensure your safety while effectively managing your heart condition.

In summary, if you have concerns about the use of Berkey enteric-coated capsules due to favism, it is essential to consult with your healthcare provider. They can provide guidance on whether to continue the medication or consider alternatives that are safe for your condition. Regular follow-up appointments and open communication about your symptoms and medication concerns will be key to managing your health effectively.

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