Fish Oil Supplement Safe to Use with Other Antiplatelets?

From Geriatric Pharmacy Intern Phuong Pham, PharmD(c)
University of Florida College of Pharmacy

Patients with cardiovascular disease typically are prescribed an anti-platelet drug, called Plavix, in combination with aspirin, to prevent the formation of blood clots. However, several studies have shown a small increase in the risk for major and minor bleeding when this combination is used. Omega-3 fatty acid, or fish oil, have been popular among consumers as a dietary supplement to lower triglycerides and as a secondary prevention of heart disease. It also has an anti-platelet property, similar to Plavix and aspirin, which raises concern about the increase risk of bleeding. In a study done by Pauline D. Watson and her colleagues at Drexel University College of Medicine in Philadelphia, they set out to study the effects of taking high-dose fish oil, Plavix, and aspirin to see if the addition of fish oil further contributes to an increase risk of bleeding when taken with the other two antiplatelets. They reviewed the medical records of 182 patients, most with coronary artery disease, being treated with high-dose fish oil (mean dose 3 g), aspirin (mean dose 161 mg), and Plavix (mean dose 75 mg), and 182 patients of similar age and gender being treated with aspirin and Plavix alone. During an average follow-up of 33 months, the researchers found one major bleeding episode in the fish oil group, no major bleeding in the control group, four minor bleeding episodes in the fish oil group, and seven minor bleedings in the control group. However, the results were not significantly different between the fish oil and control group. The authors concluded that high-dose fish oil is safe in combination with aspirin and Plavix and does not increase the risk of bleeding compared with that seen with aspirin and Plavix alone.