Synergistic platelet inhibition between Omega-3 and acetylsalicylic acid dose titration; an observational study

Harald Bagger,Thomas Kander,Mattias Hansson,Ulf Schött

doi:10.1186/s12906-020-02990-9

Harald Bagger, Thomas Kander + Show 2 more

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https://doi.org/10.1186/s12906-020-02990-9

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Abstract

BackgroundOmega-3 and acetylsalicylic acid (ASA) are two widely used “over-the-counter” drugs. Previous research has shown multiple electrode aggregometry (MEA) can detect ASA and varying Omega-3 platelet inhibiting effects. Synergistic platelet inhibiting effects of ASA and Omega-3 have been found using other methods than MEA. The aim of this study was to investigate the antiplatelet effects of Omega-3, and ASA synergism with MEA.MethodsTen healthy male volunteers ingested Omega-3 (1260 mg/day) for 5 days. MEA was used to analyse platelet function before and after Omega-3 intake. Aggregation was initiated using three different agonists and measured as area under the curve (AUC): adenosine diphosphate (ADP), thrombin receptor activating peptide (TRAP) and arachidonic acid (ASPI). Two concentrations of ASA were dose titrated ex vivo to 2 out of 3 ASPI test cells in order to measure synergism between Omega-3 and ASA.ResultsFollowing 5 days Omega-3 intake, ADP, TRAP and ASPI AUC did not change significantly. In vitro ASA before Omega-3 intake, reduced ASPI AUC < 30 U, indicating a strong platelet inhibiting effect. Below this AUC level, the 5 days Omega-3 intake increased ASPI-AUC with the ex vivo added low dose ASA (P = 0.02) and high dose ASA (P = 0.04).ConclusionsNo synergism between ASA and Omega-3 was found using the MEA ASPI test. The surprising increase in ASPI-AUC following Omega-3 intake and ex vivo ASA suggest that there are methodological issuses with the MEA ASPI test.Trial registrationTrial registration ISRCTN78027929. Registered 19 May 2015.

Highlights

Omega-3 and acetylsalicylic acid (ASA) are two widely used “over-the-counter” drugs
Omega-3 has an established antiplatelet effect, and efforts have been made to examine through which specific mechanism(s) Omega-3 fatty
There were no significant changes in the multiple electrode aggregometry (MEA) adenosine diphosphate (ADP), thrombin receptor activating peptide (TRAP) or Arachidonic acid (ASPI)-assays after Omega-3 intake (Fig. 1 and Table 1)

Summary

Introduction

Previous research has shown multiple electrode aggregometry (MEA) can detect ASA and varying Omega-3 platelet inhibiting effects. Synergistic platelet inhibiting effects of ASA and Omega-3 have been found using other methods than MEA. S adults self-reporting frequent ingestion in 2012 [1]. Aspirin (acetylsalicylic acid, ASA) is a widely used medication among adult patients for prevention of conditions such as cardiovascular disease, pain and inflammation. Between 2012 and 2015, more than 30% of U.S adults aged 40 years and older self-reported taking low dose ASA for prevention of cardiovascular disease [12]. Considering the fact that the patient group most likely to frequently ingest supplementary Omega-3, namely patients at risk for cardiovascular disease, are indicated for ASA treatment, a significant number of patients likely use both substances. The effect can be measured with MEA, but a platelet inhibiting effect does not always transfer into an increased perioperative bleeding [15]

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