Eicosapentaenoic acid blood status and outcomes in intracerebral haemorrhage

Eicosapentaenoic acid (EPA) is an omega-3 fatty acid with antiplatelet properties. This effect is at the core of protection of EPA against ischemic events. On the other side, it has raised concerns of increased risk of delayed cessation of bleeding. This might be critical in the event of an intracerebral haemorrhage (ICH). We explored whether higher circulating EPA status at hospital admission for ICH (mirroring EPA intake during the weeks prior to the event) relate to a higher risk for adverse outcomes.

We used gas-chromatography to determine EPA in serum phospholipids of 177 ICH patients. We performed neuroimaging and sequential evaluations of neurological deficits using the National Institutes of Health Stroke Scale (NIHSS). We recorded early neurological deterioration and mortality during hospitalization and at 90 days. We constructed multivariate models adjusting for age, NIHSS score, ICH location, and hematoma volume at admission. We examined the association between EPA and prevalence of adverse outcomes (in-hospital mortality; 90-day mortality; early neurologic deterioration).

There were 27 cases of in-hospital mortality, 41 cases of 90-day mortality and 35 cases of early neurologic deterioration. Compared to participants at T1 (lowest tertile) of EPA, those at T3 (highest tertile) showed a lower risk of in-hospital mortality (adjusted hazard ratio [95% confidence interval] = 0.05 [0.00,0.55]). A similar pattern was observed when considering EPA continuously. Statistical significance remained when only considering lobar ICH (14 cases/58 patients). No other relevant associations were observed.

Higher circulating levels of EPA at hospital admission for ICH were unrelated to a worse prognosis. Actually, some associations pointed to benefits, in particular for lobar ICH. This helps dispelling concerns surrounding this omega-3 regarding amplified damage in a critical bleeding event such as an ICH.