Omega-3 PUFAs may boost dual antiplatelet therapy response
MedWire News: Omega-3 polyunsaturated fatty acids (PUFAs) may improve platelet responsiveness to dual antiplatelet therapy in patients who undergo percutaneous coronary intervention (PCI), researchers say.
Oily fish consumption or PUFA supplements are recommended for the secondary prevention of cardiovascular events but their anticoagulant and antiplatelet mechanisms are unclear, observe Grzegorz Gajos (John Paul II Hospital, Cracow, Poland) and co-workers.
To investigate whether PUFA supplements can enhance dual antiplatelet treatment in patients with stable coronary artery disease after PCI, the team recruited 63 patients using aspirin 75 mg/day plus clopidogrel 600 mg loading dose followed by 75 mg/day.
In all, 33 patients were randomly assigned to receive omega-3 ethyl esters 1 g/day for 1 month, while 30 patients received placebo. Platelet function was measured at baseline, after 12 hours, and again at 30 days.
The primary endpoint of the study, the 30-day P2Y12 platelet reactivity index (PRI), determined by the phosphorylation status of the vasodilator-stimulated phosphoprotein, was 22.2% lower in patients given PUFAs than controls.
In addition, maximal platelet aggregation, measured using light transmission aggregometry after stimulation with 5 and 20 µmol/l adenosine diphosphate, was 13.3% and 9.8% lower, respectively, at 30 days in PUFA-treated patients than controls.
Arachidonic acid-induced platelet aggregation was low in both patient groups throughout the study. None of the patients had platelet resistance, defined as more than 20% aggregation after arachidonic acid stimulation, indicating that patients were adherent to their treatment.
“The addition of omega-3 ethyl esters to the standard dual antiplatelet therapy with aspirin and clopidogrel significantly potentiates platelet response to clopidogrel after PCI,” the team concludes in the Journal of the American College of Cardiology.
Gajos et al note that a 1-g dose of PUFAs was chosen as it has previously been shown to be efficacious and well tolerated in patients with acute myocardial infarction and chronic heart failure but was not thought to alter blood coagulation.
They suggest: “Higher platelet inhibition might be achieved with increased doses of omega-3 PUFAs.”
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By Lynda Williams