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n-3 Fatty acids affect haemostasis but do not increase the risk of bleeding: clinical observations and mechanistic insights
Open accessAbstract
n-3 Fatty acids (EPA and DHA, from fish oil) are essential fatty acids that are approved for the treatment of severe hypertriacylglycerolaemia and, in some countries, used for reducing the risk of CVD. Because of their inhibitory effects on platelet function, some practitioners have, perhaps unnecessarily, discontinued their use in patients undergoing invasive procedures or being treated with anti-platelet or anticoagulation drugs. Thus, the aim of the present study was to review the effects of n-3 fatty acids on bleeding complications in a wide variety of clinical settings, and to summarise their biochemical mechanism of action in platelet function and coagulation. We surveyed recent publications that either directly studied the effects of n-3 fatty acids on the risk of bleeding or focused on different end-points and also reported the effects on bleeding.n-3 Fatty acid treatment had no effect on the risk of clinically significant bleeding in either monotherapy or combination therapy settings. Although originally believed to operate primarily via the cyclo-oxygenase system, these fatty acids have been shown to affect multiple signalling pathways and thrombotic processes beyond simply affecting platelet aggregation. The present overview found no support for discontinuing the use of n-3 fatty acid treatment before invasive procedures or when given in combination with other agents that affect bleeding. On the contrary, the use of these fatty acids in several settings improved clinical outcomes.
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Trials report no increased risk of bleeding when omega-3 fatty acids are added to anticoagulants or antiplatelet drugs.
“This is consistent with trials reporting no increased risk of bleeding with n-3 FA added to either anticoagulants or antiplatelet drugs.94,95”
From Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association (2019) · cites this paper as [95]
The presumed protective effect of omega-3 against stroke may relate to the mild anti-thrombotic effects of EPA and DHA.
“This presumed protective effect against stroke may relate to the mild anti-thrombotic effects of EPA and DHA127, 128.”
From Effects of Omega-3 Fatty Acid Treatment on Risk for Atrial Fibrillation: An Updated Meta-Analysis of 35 Trials including 114 592 Individuals (2026) · cites this paper as [128]
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Metadata
- Authors
- Wachira, J. K., Larson, M. K., & Harris, W. S.
- Affiliations
- University of South Dakota (US)
- Augustana University (US)
- Corresponding author
- Wachira, John K.
- ORCID
- Harris, William S.
- Venue
- British Journal of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2014-01-28
- Volume
- 111
- Issue
- 9
- Pages
- 1652-1662
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- OpenAlex
- W2169632752
- Cited by
- 91
- References
- 88
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 7 · 2019: 11 · 2018: 13 · 2017: 9 · 2016: 15 · 2015: 10 · 2014: 4
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Hematology › Platelet Disorders and Treatments
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- omega-3 fatty acids, eicosapentaenoic acid, docosahexaenoic acid, fish oil, hemostasis, bleeding risk, platelet function, platelet aggregation, coagulation, antiplatelet agents, anticoagulants, invasive procedures, hypertriglyceridemia, cardiovascular disease
- MeSH terms
- Hypolipidemic Agents, Dietary Fats, Dietary Fats, Unsaturated, Fish Oils, Hemorrhage, Hemostasis, Humans, Models, Biological, Risk, Fatty Acids, Omega-3, Evidence-Based Medicine, Dietary Supplements
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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