Abstract 8238: Relationship Between Red Blood Cell Omega-3 Fatty Acid Index and Bleeding During Hospitalization for Acute Myocardial Infarction
Background: Omega-3 fatty acids have established cardiovascular benefits, but may also inhibit platelet aggregation and increase bleeding. If this platelet inhibition is clinically meaningful, patients with the highest omega-3 indices (red blood cell eicosapentaenoic plus docosahexaenoic acid), which reflect long-term omega-3 fatty acid intake, should be at the greatest bleeding risk, particularly in the setting of acute myocardial infarction (AMI) when patients are aggressively treated with antithrombotic agents and frequently undergo invasive procedures.
Methods: We studied 1523 patients from 24 US centers who had their omega-3 index assessed at the time of AMI. The rates of serious bleeding (TIMI major & minor) and mild-moderate bleeding (TIMI minimal) were identified in patients with low (<4%), intermediate (4-8%) and high (>8%) omega-3 indices. We used separate hierarchical modified Poisson models to identify the independent association between the omega-3 index and bleeding adjusting for age, gender, creatinine, heart failure, peripheral arterial disease, cath/PCI, and use of thienopyridines, warfarin, heparin, bivalirudin and GP IIb/IIIa inhibitors. Potential interactions between omega-3 index and antithrombotic medications were tested.
Results: Omega-3 indices were high in 5.2% of patients, intermediate in 68.0% and low in 26.8%. There were no differences in bleeding across omega-3 index categories. There were also no significant differences in bleeding rates between those on omega-3 supplements and patients who were not (serious bleeding: 14/251 (5.5%) using omega-3 supplements vs. 103/1258 (8.2%) of patients who were not taking omega-3 supplements [p=0.16]; mild-moderate bleeding: 17/251 (6.8%) using omega-3 supplements vs. 67/1258 (5.3%) not taking omega-3 supplements[p=0.42]). There was no multivariable adjusted association between the omega-3 index and either serious (per 2% increase: RR 1.02, 95% CI 0.88-1.18) or mild-moderate (per 2% increase: RR 1.02, 95% CI 0.85-1.22) bleeding. There were no interactions between omega-3 index and antithrombotic medications (all p>0.05).
Conclusions: We found no relationship between the omega-3 index and bleeding in this large, multicenter cohort of AMI patients.
- © 2011 by American Heart Association, Inc.