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27-09-2011 | Cardiometabolic | Article

Bleeding risk in AMI not increased by omega-3 consumption


Free abstract

MedWire News: Study findings suggest that patients hospitalized with acute myocardial infarction (AMI) who are advised to use omega-3 supplements or increase their fish consumption are not at an increased risk for bleeding compared with those who are not.

"Patients with AMI are at particularly high risk for in-hospital bleeding because of intensive treatment with multiple potent antithrombotic agents (such as intravenous heparin, glycoprotein IIb/IIIa inhibitors, and dual-antiplatelet therapy) and the use of invasive diagnostic and therapeutic procedures," explain Adam Salisbury (University of Missouri-Kansas City, USA) and colleagues in the American Journal of Cardiology.

"Omega-3 fatty acids have multiple cardiovascular benefits but may also inhibit platelet aggregation and increase bleeding risk," they write. If this platelet inhibition is clinically meaningful, patients with the highest omega-3 indexes (red blood cell eicosapentaenoic acid plus docosahexaenoic acid), which reflect long-term omega-3 fatty acid intake, should have a greater risk for bleeding than those with lower indexes.

The researchers therefore investigated the relationship between omega-3 index and bleeding in 1523 patients (aged ≥18 years), from 24 hospitals, who had their omega-3 indexes assessed at the time of AMI.

All in-hospital bleeding events, the site of bleeding (cardiac catheterization site, gastrointestinal, intracranial, retroperitoneal, or other), and the severity of bleeding, using the Thrombolysis In Myocardial Infarction (TIMI) classification, were recorded.

Serious bleeding was defined as TIMI major (intracranial hemorrhage or a bleeding event with a hemoglobin decrease >5 g/dl) or minor (bleeding episode with a hemoglobin decrease of 3-5 g/dl) bleeding. Mild to moderate bleeding was defined as TIMI minimal (bleeding episode with a hemoglobin decrease <3 g/dl) bleeding.

At the time of AMI, 26.8% of patients had low omega-3 indices (<4%), 68.0% had intermediate values (4-8%), and 5.2% had high omega-3 indices.

The researchers report no significant association between the omega-3 index and either serious bleeding or mild to moderate bleeding, and no significant differences in the site of bleeding across omega-3 index categories. Similarly, multivariate analysis yielded no significant associations between bleeding and the omega-3 index.

These findings suggest that there is "little reason for concern about excessive bleeding in patients who take fish oil supplements concurrent with modern medical therapy for AMI," conclude Salisbury et al. "Concerns about bleeding should not preclude the use of omega-3 supplements or increased fish consumption when clinically indicated," they add.

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By Nikki Withers