CONGRESS ABSTRACT

Introduction: Favism is an acute hemolytic anemia triggered by the ingestion of fava beans or exposure to specific oxidative stressors in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Certain drugs can induce red blood cell destruction and should therefore be avoided. Case report: A 55-year-old man presented to the emergency room with typical chest pain.  Echo and ECG were unremarkable while cardiac troponin I showed a typical rise-and-fall pattern. He was then admitted to the ICU with a diagnosis of NSTEMI-ACS. Past medical history included active smoking and a childhood hospitalization for an episode of jaundice and anemia requiring blood transfusion, which occurred while he was in the countryside harvesting fava beans. Coronary angiography revealed an acute thrombotic occlusion of the RCA at the mid-proximal tract, treated with pPCI. Due to an episode of slow-reflow, tirofiban infusion was initially administered, followed by dual antiplatelet therapy (DAPT) with ticagrelor plus cardioaspirin. In the following days, the patient complained of dyspnea after taking ticagrelor, in the absence of signs and symptoms of hemolysis. Therefore switch from ticagrelor to clopidogrel was made. Given the high clinical suspicion of favism, a G6PD enzyme activity test was performed, revealing a severe deficiency (activity 7% of normal) and confirming the diagnosis. During the remaining days of hospitalization, the patient was asymptomatic, and there were no alterations in hemoglobin or bilirubin levels. He was discharged after 5 days in good clinical condition. Conclusions: Anti-thrombotic treatment is a cornerstone in managing acute coronary syndromes, including in G6PD-deficient patients. While low-dose aspirin is considered safe, data on the use of other antiplatelet drugs are limited in the literature. This case report highlights the safety of various anti-thrombotic drugs (aspirin, ticagrelor, tirofiban, and clopidogrel) in G6PD deficiency.