Omega-3 fatty acids, combined with two blood-thinning drugs, significantly changed the blood-clotting process and may reduce the risk of heart attacks in patients with stents in their heart arteries.
Foods rich in omega-3, such as salmon and other oily fish, have been previously shown in other studies to reduce the risk of heart problems in people with coronary artery disease.
In this clinical trial, participants were given daily fish oil supplements providing 1,000 milligrams omega-3 fatty acids (EPA+DHA) and were encouraged to boost their consumption of oily fish.
This double-blind, placebo-controlled trial sought to determine what effects omega-3 might add to those of aspirin and clopidogrel.
According to lead author Grzegorz Gajos, M.D., Ph.D., “There are no other studies on omega-3 effects in patients who were already being treated with optimal medical therapy after stent placement. We were looking for any effect and what it might be.” (AHA 2012)
Trial finds omega-3s add to clot-busting drugs' benefits
The Omega-PCI Study found that patients who received the omega-3 pills with aspirin and clopidogrel had blood clots more susceptible to destruction than patients who received only the two blood thinners.
The research team focused on the clot-forming protein fibrin, and the interlaced structure it forms in coagulated blood.
Dr. Gajos and his colleagues examined findings from 54 patients (41 men, 13 women, average age 62.8 years) who participated in the trial conducted at John Paul II Hospital in Krakow, Poland.
This study evaluated the effects of omega-3 in patients with stable coronary artery disease who had their clogged heart arteries opened by a catheter procedure and a stent successfully inserted to help keep the vessels opened.
Previously, the researchers had reported that adding omega-3 to the anti-platelet drug clopidogrel after placement of an arterial stent significantly lowered the “platelet response” in clotting.
The researchers randomly selected 24 patients as controls and 30 for treatment.
Both groups received the same daily doses of aspirin and clopidogrel for four weeks after stenting.
The treatment group received 1,000 milligrams of omega-3s daily, while the controls received a placebo each day.
The study showed that, in comparison with the control group, the omega-3 treated patients:
Produced less of a clot-promoting factor called thrombin.
Had less oxidative stress, which promotes inflammation and clotting.
Showed no significant changes in fibrinogen and clotting factor (II, XIII) levels.
Formed clots with an altered and favorable structure — including larger pores — that made them easier to disrupt and reduced the clot-destruction time by 14.3 percent.
The beneficial change to clot structure might prove important in protecting patients, especially those with stents that slowly release a drug to prevent fibrosis … a process that, together with clot formation, could block the stented artery, leading to potentially fatal clots.
“Our study suggests that combined moderate anti-thrombotic and anti-platelet actions of omega-3, when added to those of other treatments, may improve outcomes for coronary artery disease patients,” Gajos said (AHA 2012).
The study participants experienced only mild adverse side effects and the number of events did not vary significantly between the two groups.
There were not enough participants to assess clinical benefit from the changes in the clotting process.
Another limitation of the study was the inability to confidently extrapolate the findings to healthy individuals, those with a high coronary artery disease risk, and those not taking aspirin and/or clopidogrel.
As Dr. Gajos said, “We are planning a larger follow-up study that will include outcomes and continue indefinitely.” (AHA 2012)
American Heart Association AHA). Omega-3 may cut risk of artery disease, heart attacks for patients with stents. May 26, 2011 AHA. Accessed at http://newsroom.heart.org/pr/aha/1346.aspx
Gajos G, Zalewski J, Rostoff P, Nessler J, Piwowarska W, Undas A. Reduced thrombin formation and altered fibrin clot properties induced by polyunsaturated omega-3 fatty acids on top of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (OMEGA-PCI clot). Arterioscler Thromb Vasc Biol. 2011 Jul;31(7):1696-702. Epub 2011 May 26.