Green tea consumption effects on coagulation profile

Ahmed Mohammed Elnour Elkhalifa; Nada Yassin; Mohammed I Tabash; Albashir M M. Tom; Ebitsam H Msahad; Lina M H. Alnor; Mohammed Mohajar; Nahla Mahdi; Shadia Elnour; Mohammed A AL-Mohaithef

doi:10.4103/joah.joah_77_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 11 | Issue : 4 | Page : 191-194

Green tea consumption effects on coagulation profile

Ahmed Mohammed Elnour Elkhalifa¹, Nada Yassin², Mohammed I Tabash³, Albashir M M. Tom², Ebitsam H Msahad², Lina M H. Alnor², Mohammed Mohajar², Nahla Mahdi², Shadia Elnour², Mohammed A AL-Mohaithef⁴
¹ Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, KSA; Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosi, Sudan
² Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosi, Sudan
³ Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Azhar University, Gaza, Palestine
⁴ Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, KSA

Date of Submission	21-May-2020
Date of Decision	01-Aug-2020
Date of Acceptance	15-Aug-2020
Date of Web Publication	17-Nov-2020

Correspondence Address:
Dr. Ahmed Mohammed Elnour Elkhalifa
Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh; Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosi

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/joah.joah_77_20

Abstract

OBJECTIVES: The objective was to study the prothrombin time (PT) and activated partial thromboplastin time (APTT) values among Sudanese regularly drinking green tea.
METHODS: This comparative study was conducted from May to November 2018 at the cities of Kosti, Rabak, and Sinnar, Sudan. Two hundred volunteers recruited in this study included individuals who drank more than three cups of green tea per day for at least 1 year or more (n = 100), and another group represented individuals who did not drink green tea (n = 100). Blood samples were collected in ethylenediaminetetraacetic acid and trisodium citrate anticoagulant containers. Coagulometer analyzer machine and standard methods were used for PT and APTT analysis.
RESULTS: The study results showed significantly prolonged in both PT and APTT mean values of individuals who drank green tea when compared with those who did not drink green tea. The PT mean values are 19.88 ± 3.7 s vs. 15.43 ± 0.52 s (P < 0.001) and the APTT mean values are 34.94 ± 3.4 s vs. 32.86 ± 3.2 s (P < 0.002). The multiple linear regression analysis confirmed a positive impact relationship between age, drinking green tea, and duration time of drinking green tea with both PT and APTT values.
CONCLUSION: The study concludes that daily drinking green tea for a long time could affect an individual's coagulation profile.

Keywords: Activated partial thromboplastin time, green tea, prothrombin time, Sudan

How to cite this article:
Elnour Elkhalifa AM, Yassin N, Tabash MI, M. Tom AM, Msahad EH, H. Alnor LM, Mohajar M, Mahdi N, Elnour S, AL-Mohaithef MA. Green tea consumption effects on coagulation profile. J Appl Hematol 2020;11:191-4

How to cite this URL:
Elnour Elkhalifa AM, Yassin N, Tabash MI, M. Tom AM, Msahad EH, H. Alnor LM, Mohajar M, Mahdi N, Elnour S, AL-Mohaithef MA. Green tea consumption effects on coagulation profile. J Appl Hematol [serial online] 2020 [cited 2021 Feb 28];11:191-4. Available from: https://www.jahjournal.org/text.asp?2020/11/4/191/300773

Introduction

Tea has many different types including green tea, black tea, white tea, yellow tea, and oolong tea.^[1] Green tea is a natural product made from the Camellia sinensis plant, which uses as a type of beverage worldwide consumed in many countries, especially in Japan, China, Morocco, and Saudi Arabia.^{[1],[2],[3],[4]} However, green tea was used in Asia for more than 4000 years.^[5],[6] The green tea was prepared without fermentation and heating with a powerful source of polyphenolic, flavonoid, and other antioxidants.^[7],[8] Green tea antioxidant activity components from the various brands were reported in previous studies which demonstrated a role in human health via modulation of the biological process, including biochemical and molecular pathways.^[7],[8],[9] The polyphenol content mainly flavonols have a meaningful role in reducing cardiovascular disease risk through an improvement of vascular function and alteration the level of inflammation.^[2],[3] Polyphenolic compounds from green tea extract showed several biological with various pharmacological beneficial effects.^[7],[8],[10] Previous studies investigated the effects of green tea on different diseases, which include decreases in fasting blood sugar, improvement in glucose control in patients with diabetes, reduction of blood pressure, and antithrombotic activities.^{[11],[12],[13],[14]} Components of green tea play a pivotal role in the prevention of cardiovascular diseases, cancers, type II diabetes, reduction of atherosclerosis and incidence of hyperlipidemia, and improvement of metabolic syndrome indices.^[15],[16] Regular green tea consumption associated with improved prognosis of breast cancer patients and decreased the risk of recurrent of tumors.^[17] Other studies conclude that green tea polyphenols and its constituent epigallocatechin gallate have chemoprevention and a protective effect of coronary artery disease (CAD).^[18],[19] However, natural products have been reported with apparent inhibitory activity on thrombotic diseases at both experimental and clinical stages and provide a useful preventive approach for thrombotic diseases. and will provide new insights to promote human health.^[20] In Sudan, drinking green tea is one of the most popular habits, even though daily consumption may negatively affect health.^[3] The objective of this study is to determine the likelihood changes in prothrombin time (PT) and activated partial thromboplastin time (APTT) values among the Sudanese who drink more than three cups of green tea per day for at least 1 year or more.

Methods

Study design

This comparative study was conducted at Kosti, Rabak, and Sinnar cites, Sudan, between May and November 2018. Two hundred volunteers, males and females, with ages between 20 and 60 years were recruited to take place in the current study. The participants were divided into two gender and age-matched groups: the first group included individuals who drank more than three cups of green tea per day for at least 1 year or more (n = 100) and another group represented individuals who did not drink green tea (n = 100).

Inclusion and exclusion criteria

Both male and female adult volunteers, who drank more than three cups of green tea per day for at least 1 year or more, participated in this study. Adult males and females who drink green tea with cardiovascular disease, liver disease, and presence with any disease have a significant effect on coagulation, history of alcoholism, on current drug effects on coagulation profile, and long term with medication (warfarin, heparin, and aspirin), and those who ignored to participate were excluded. The same mentioned excluded criteria also were applied to the other group who did not drink green tea.

Laboratory procedures and data collection

Venous blood samples were collected in trisodium citrate anticoagulant containers for PT and APTT analysis using (coagulometer machine) standard methods.

Ethical considerations

According to the Helsinki Declaration principles, each participant completed an informed consent form before taking samples. Ethical approval was obtained from the Committee of Research Ethics, Faculty of Medical Laboratory, El imam El Mahdi University, Sudan.

Statistical analysis

The demographic and the laboratory result data were coded, revised, and proceeded to the statistical software program IBM SPSS (Statistical Package for the Social Sciences) version 24 (IBM Corp., Armonk, NY, USA). Descriptive statistics include frequency distribution and percentage and mean and standard deviation. A comparison between the two types of the participants' differences was done by applying t-test, one-way ANOVA, and multilinear regression methods. The two-tailed tests with an alpha error of 0.05 were considered statistically significant for P ≤ 0.05.

Results

The current study results revealed that 54% of the study population are male and 46% female. The rang of respondents ages was between 20 to 60 years old, with a mean age of 37.5 years old and standard deviation [SD] ±10.1 years old. Of the study population, 61% were drinking green tea for 1–2 years, while 39% were drinking green tea regularly for more than 2 years, at least three cups per day. [Table 1] confirms the prolonged PT mean values with individuals who drank green tea, and there were statistically significantly different between the PT mean values of the drinking green tea group and nondrinking green tea individuals (P < 0.001), with a higher mean (19.88 ± 3.7 s) for drank green tea than the nondrank green tea (15.43 ± 0.52 s). The results show the more drinking period of green tea, the more PT prolonged with statistically significant variations about PT and the duration of drinking green tea (P = 0.035), with a higher mean (18.57 ± 4.64 s) for individuals drank green tea more than 2 years than the other group (17.06 s ± 2.37 s).

Table 1: The effects of green tea on prothrombin time values among the study population

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[Table 2] shows the prolonged APTT mean values in the drinking green tea group (34.94 ± 3.4 s) showing a statistically significant difference when compared with the nondrinking green tea group (32.86 ± 3.2 s) (P = 0.002). However, the results show a longer duration period of APTT in participants drinking green tea with statistically significant differences between the duration time of drinking green tea and APTT (P = 0.028), with a higher mean (34.84 ± 2.98 s) for a longer duration of drinking green tea, more than 2 years.

Table 2: The effects of green tea on activated partial thromboplastin time value among the study population

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[Table 3] summaries the findings of multiple linear regression analysis that shows a significant impact of both PT and APTT measures. The results revealed that age category, drinking of green tea, and duration time of drinking green tea have a significant association with prolonged PT and APTT.

Table 3: The effects of green tea on prothrombin time and activated partial thromboplastin time values among the study population (multiple linear regression)

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Discussion

Slight variation in results reported an antithrombotic value in different previous studies among regularly drinking green tea people for a long time.^[21] The present study was conducted to determine PT and an APTT values as routine parameters requested by physicians and try to find any evidence of their effects on Sudanese who regularly drink green tea at least three or more cups per day for 1 year or more and compared their findings with apparently healthy participants who did not drink green tea. The green tea components play a pivotal role in the prevention of cardiovascular diseases, CAD, fibrinolysis activity, decreasing blood viscosity, and improvement of blood flow dynamics, and their impacts on thrombotic tendency may be due to the existence of antioxidative polyphenols that showed several pharmacological beneficial effects in vascular functioning in humans and affect biochemical and molecular pathways.^{[18],[19],[20]} According to the current findings, the PT and APTT mean value results show statistically significantly prolonged in the participants who drank green tea when compared with the participants who did not drink green tea [Table 1] and [Table 2]. These study findings are inconsistent with some previous studies done in 2017 in Sudan and 2016 in China^[3],[22] who obtained no significant difference between the green tea drinkers and the nongreen tea drinkers regarding PT and APTT. Different results reported in the study completed in 2008 by Jalali et al. showed significantly decreased PT and APTT values in the participants who drank green tea.^[23] Current results not in agreement with the mentioned previous studies could be due to the large study sample size, the duration period, and the amount of daily green tea consumption. However, there is a statistically significant difference between the duration of drinking green tea with a higher mean for individuals who drank green tea for more than 2 years. Although the slight increase in the mean value of PT and APTT, there is no statistically significant difference between male and female who drank green tea [Table 1] and [Table 2]. The multiple linear regression analysis shows a significant difference between PT and APTT regarding age category, drinking of green tea, and duration time of drinking green tea [Table 3]. The effect on PT regarding younger age group than older group age may be due to the amount of green tea consumption by youngers, however, most of the study groups are younger, 78% of the age range 20–50 years.

Conclusion

Our study results have shown drinking green tea regularly for a long time three cups or more per day for 1 year or more and prolonged PT and APTT. These findings suggest that drinking green tea could benefit as a preventative strategy to reduce the risk of developing blood clots and thrombosis disease risk. We recommend further studies to identify green tea various components and to determine how these components contribute to antithrombotic functions.

The study limitations

The study did not include the appropriate test of functional defects of thrombotic pathways and liver function test, fibrinogen or thrombin time, and a detail of a coagulation methodology used.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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