Influence of a Concentrated Ethylester Compound of n-3 Fatty Acids on Lipids, Platelets and Coagulation in Patients Undergoing Coronary Bypass Surgery

Abstract

SummaryTwenty patients accepted for coronary bypass surgery were randomized to receive either a concentrated ethylester compound of n-3 fatty acids, with a daily dose of 3.15 g of eicosapentaenoic acid (EPA) and 1.89 g of docosahexaenoic acid (DHA), or corn oil (controls) in a double blind study, to evaluate the effect on lipids, platelets and coagulation during the pre- and postoperative phase.Only patients with fasting triglyceride (TG) levels ≥1.6 mmol/1 at recruitment were eligible. The study was continued for 5 to 6 months. Surgery was usually performed at mid-intervention. Blood samples were collected during morning hours in fasting subjects, just prior to intervention, preoperatively and at final postoperative follow-up. Moreover, blood loss was accurately accounted for postoperatively.A threefold increase (p = 0.0001) of EPA was noted at pre-and postoperative follow-up. TG-levels were reduced 20 and 39%, respectively, in patients on n-3 fatty acids, reaching statistical significance at end of intervention (p = 0.034). TG-levels in controls remained largely unchanged. In patients on n-3 fatty acids, there was a statistically significant increase in serum total cholesterol preoperatively, but this change was no longer present at completion of the study.No significant changes were noted in platelet function, as judged by bleeding time, collagen induced platelet aggregation and release of TxB2 during aggregation. Parameters of extrinsic coagulation, including phospholipase C-sensitive factor VII (PLC-VII) and extrinsic pathway inhibitor (EPI), also remained essentially unchanged in both groups of patients. However, fibrinogen was significantly reduced in controls (p <0.05) at end of intervention. Moreover, a strong positive correlation was noted between PLC-VII and TG (r = 0.77, p = 0.0001).No significant difference in postoperative bleeding was noted between the two groups of patients.

A Double-Blind Randomized Trial of Fish Oil to Lower Triglycerides and Improve Cardiometabolic Risk in Adolescents

“…20 In a study by Vanschoonbeek et al, 21 4 weeks of fish oil treatment resulted in reduced thrombin generation and fibrinogen levels in healthy volunteers; however, the effect was variable and more pronounced in those with a structural fibrinogen alpha-chain polymorphism. Very recent studies have suggested that exogenous modification of platelet membranes by omega-3 fatty acids results in decreased platelet procoagulant activity and thrombus formation.…”

Dietary Polyunsaturated Fatty Acids and Age‐Related Membrane Changes in the Heart

“…Prostacyclin, a vasodilator eicosanoid, is produced from the ω‐6 PUFA, AA, and the ω‐3 PUFA, EPA, whereas the active form of the vasoconstrictor, thromboxane, is only produced from the ω‐6 PUFA, AA. It is widely accepted that a low ratio of EPA/AA predisposes to a balance of eicosanoids, favoring vasoconstriction, platelet aggregation, inflammatory mediator signaling and cardiac arrhythmias 16,18–23 . During acute stress, augmented free radical production, peroxidation of ω‐6 PUFA, and production of specific prostanoids, leukotrienes, cytokines, and other inflammatory mediators promote metabolic, ionic, and electrical instability, and depress contractile dysfunction 18–23 .…”

“…It is widely accepted that a low ratio of EPA/AA predisposes to a balance of eicosanoids, favoring vasoconstriction, platelet aggregation, inflammatory mediator signaling and cardiac arrhythmias. 16,[18][19][20][21][22][23] During acute stress, augmented free radical production, peroxidation of -6 PUFA, and production of specific prostanoids, leukotrienes, cytokines, and other inflammatory mediators promote metabolic, ionic, and electrical instability, and depress contractile dysfunction. [18][19][20][21][22][23] Recently it has been shown in CABG surgery patients that epicardial adipose tissue around the proximal coronary arteries is a rich source of inflammatory cytokines, such as IL-6, IL-1␤, TNF-␣, and that surgery promotes their release.…”

Uses and benefits of omega-3 ethyl esters in patients with cardiovascular disease

“…60,111 Moreover, changes in levels of fibrinogen, factor VII or VIII, or von Willebrand factor generally did not significantly differ between recipients of 1000-6000 mg/day omega-3 EE and controls in healthy volunteers, 112 post-MI patients, 110 patients with mild hypertension, 81 patients with combined hyperlipidemia 109 or patients undergoing coronary artery bypass graft (CABG) surgery. 113 Bleeding time was prolonged in 40 post-MI patients after four weeks of 3400 mg/day EPA-DHA, without significant alteration of other hemostatic parameters, 114 and increased in one study in CAD patients. 115 At variance with previous studies, omega-3 EE 6000 mg/day did not affect bleeding time at rest in patients with familial hypercholesterolemia, 100,113 or in patients undergoing CABG surgery.…”

“…113 Bleeding time was prolonged in 40 post-MI patients after four weeks of 3400 mg/day EPA-DHA, without significant alteration of other hemostatic parameters, 114 and increased in one study in CAD patients. 115 At variance with previous studies, omega-3 EE 6000 mg/day did not affect bleeding time at rest in patients with familial hypercholesterolemia, 100,113 or in patients undergoing CABG surgery.…”