Role of Fish Oil in Post-Cardiotomy Bleeding: A Summary of the Basic Science and Clinical Trials.

BACKGROUND: Omega-3 fatty acids are widely used. This article reviews the coagulopathic effects of fish oil.

METHODS: A review was performed of all English articles that addressed the topic from 1980 to 2017.

RESULTS: Fish oil induces an in vitro coagulopathy in humans due to inhibitory effects in platelet-to-platelet adhesion and platelet-stimulated thrombin generation. The effect from fish oil alone is weak, but it is enhanced and may become clinically noticeable in patients taking antiplatelet therapy, and, to a lesser extent, in patients on factor Xa inhibitors and warfarin. In the absence of other anticoagulants, fish oil alone is not capable of producing a clinically significant coagulopathy that would induce or contribute to surgical bleeding.

CONCLUSIONS: Patients who are taking fish oil without other anticoagulants do not have an increased risk of bleeding surgical complications. Because of the highly variable amounts of actual eicosapentaenoic acid and docosahexaenoic acid in commercially available supplements, thromboelastography with platelet mapping would allow a surgeon to know if a coagulopathic effect is present in a patient taking fish oil, especially if the patient was also taking other anticoagulants.