Abstract: Low mortality rate of about 1.5% and optimism bias have changed the attitude of general public towards COVID-19. Though COVID-19 cases are increasing in India but mostly they remain in mild stage with 92.6% recovery and 1.48% mortality rate till 10th Nov. 2020 as per WHO reports. According to another study more than 75% of patients experience mild to moderate symptoms and recover without hospitalization. Just 5% patients progress to critical stage with 2-2.5% mortality rate. COVID-19 associated coagulopathy (CAC), the main cause of mortality have been reported mainly in subgroup of patients with comorbidities like CVD, hypertension, diabetes and cancer etc.
OBJECTIVE:- Our objective is to identify the factors responsible for COVID-19 symptoms progressing to life threatening CAC and their management.
DISCUSSION:- Excessive coagulation with fibrinolytic shutdown is the hallmark of CAC. Cytokine storm induced over expression of Tissue Factor is the potential trigger for CAC. Pharmacological properties of aspirin, like anti-inflammatory and antithrombotic can be used as an evidence to hypothesize its use as a primary preventive treatment for CAC. Most of the patients are already taking aspirin for this purpose. But rising trend in aspirin resistance has made aspirin totally undependable. Omega-3 index (Omega-6/ omega-3 ratio) determines cardiovascular health. More than 8% is cardioprotective and less than 4% leads to major adverse cardiac events. Omega-3 reduces platelet aggregation, coagulation and thrombosis. High omega-6 levels cause coagulation. Omega-6 fatty acid (AA) is the substrate for the synthesis of a variety of proinflammatory/ proaggregatory molecule such as prostaglandin E2, thromboxane A2 (TXA2), & leukotriene B4.
CONCLUSION: - Low Omega-3 index (High Omega-6/ omega-3 ratio) promotes coagulopathy. This can be corrected by adequate omega-3 nutrients (EPA and DHA) supplementation. Administration of EPA & DHA helps in replacing omega 6 fatty acids (such as AA) resulting in reduction of TXA2. Co-administration of Aspirin, EPA & DHA have shown positive results as an antiplatelet treatment. This also makes aspirin more effective by increasing its sensitivity. We hypothesize that co-adminisration of EPA + DHA + Aspirin may prove to be very useful as a primary preventive antithrombotic option in CVD patients. This can also check progression from mild COVID-19 symptoms to life threatening CAC.
Keywords: COVID-19, Aspirin, Omega-3 Fatty Acids, Coagulopathy.
Title: ASPIRIN RESISTANCE & LOW OMEGA-3 INDEX – GREATER CHANCES OF CVD MORTALITY ESPECIALLY IN COVID-19
Author: Dr. Manoj Kumar, Dr. Nishant Tyagi, Mahima Singla, Himanshu Bhatia, Aaeesha Vyas, Ved Sharma
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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