Natural Medicines Newsletter

Volume 1, Issue 43, 11/12/2009

Question

How does fish oil (omega-3 fatty acids; EPA; DHA or Lovaza) potentially increase the risk for bleeding or affect platelet aggregation?

Answer

This is part one of a two part series.  Fish oil has been used to treat a number of conditions which include asthma, diabetes mellitus, rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, hyperlipidemia and cardiovascular disease (CVD).(1-6) As it relates to CVD, fish oil is most commonly used to treat high triglycerides (hypertriglyceridemia).  When clinicians refer to the use of "fish oil", they are generally referring to omega-3 fatty acids (also known as polyunsaturated fatty acids (PUFA)).  These specific omega-3 fatty acids include docosahexaenoic acid (DHA; 22:6n-3) and eicosapentaenoic acid (EPA; 22:5n-3).(7)  For the most part, neither DHA nor EPA cause any major side effects or clinically relevant drug interactions, but they are known to influence platelet function.  As such, some clinicians perceive that this can put the patient at greater risk of bleeding, especially during surgical procedures or while on other medications that are known to affect coagulation and platelet aggregation.  

How do omega-3 fatty acids affect platelet function and possibly increase the risk for bleeding in certain situations?
After a platelet has been activated, a number of intracellular reactions and changes take place to prepare the platelet for binding during the formation of a primary hemostatic plug, and to help recruit or activate other nearby platelets.  One of these... 

The complete answer to this question also comes with a figure that describes the mechanism of action for this effect.

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