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Omega-3 fatty acids increase platelet response to clopidogrel

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Adding omega-3 polyunsaturated fatty acids (PUFAs) to dual antiplatelet therapy after stent implantation boosts patients’ platelet response, investigators in Poland report.

The P2Y12 reactivity index was significantly lower after 1 month of treatment with omega-3 ethyl esters compared to placebo, according to lead author Dr. Grzegorz Gajos, from John Paul II Hospital in Cracow, and his colleagues.

Reactivity of the P2Y12 receptor, through which adenosine diphosphate (ADP) induces platelet aggregation – was the primary endpoint of the study.

Because omega-3 PUFAs reportedly have antithrombotic activity and are recommended for secondary cardiovascular prevention, the researchers randomized 33 patients to take 1000 mg once daily and 30 to receive placebo.

All participants were taking clopidogrel (600 mg loading dose followed by 75 mg/day) plus aspirin 75 mg/day after stent implantation. The PUFAs contained ethyl esters of 460 mg eicosapentaenoic acid and 380 mg docosahexaenoic acid.

In the April 20th issue of the Journal of the American College of Cardiology, the authors report that on day 30, the P2Y12 reactivity index was 22.2% lower in the omega-3 PUFA group than in controls (p = 0.02). In addition, maximal platelet aggregation as induced by 5 umol/L ADP was 13.3% lower in the PUFA group.

Light transmission aggregometry done after ADP challenge showed rates of clopidogrel resistance to be 18.2% with PUFA vs 43.3% with placebo (p = 0.03).

The researchers conclude: “The addition of omega-3 ethyl esters to the combination of aspirin and clopidogrel significantly potentiates platelet response to clopidogrel after percutaneous coronary intervention.”


J Am Coll Cardiol 2010;55:1671-1678.