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Cited by 58Fatty Acid Research and HealthAntiplatelet Therapy and Cardiovascular DiseasesInflammatory mediators and NSAID effects

Bleeding risk in patients receiving omega-3 polyunsaturated fatty acids: a systematic review and meta-analysis of randomized clinical trials

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Javaid, Mustafa, Kadhim, Kadhim, Bawamia, Bilal, Cartlidge, Timothy, Farag, Mohamed, Alkhalil, Mohammad·2024·Journal of the American Heart Association
DOI 10.1161/jaha.123.032390PMC PMC11179820
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Abstract

Background: There is a potential concern about increased bleeding risk in patients receiving omega‐3 polyunsaturated fatty acids (PUFAs). The aims of this study‐level meta‐analysis were to determine the risk of bleeding and to assess whether this relationship is linked to the received dose of omega‐3 PUFAs or the background use of antiplatelet treatment. Methods and Results: Electronic databases were searched through May 2023 to identify randomized clinical trials of patients receiving omega‐3 PUFAs. Overall bleeding events, including fatal and central nervous system events, were identified and compared with those of a control group. A total of 120 643 patients from 11 randomized clinical trials were included. There was no difference in the pooled meta‐analytic events of bleeding among patients receiving omega‐3 PUFAs and those in the control group (rate ratio [RR], 1.09 [95% CI, 0.91–1.31]; P =0.34). Likewise, the incidence of hemorrhagic stroke, intracranial bleeding, and gastrointestinal bleeding were similar. A prespecified analysis was performed in patients receiving high‐dose purified eicosapentaenoic acid (EPA), which demonstrated a 50% increase in the relative risk of bleeding but only a modest increase in the absolute risk of bleeding (0.6%) when compared with placebo. Bleeding risk was associated with the dose of EPA (risk difference, 0.24 [95% CI, 0.05–0.43]; P =0.02) but not the background use of antiplatelet therapy (risk difference, −0.01 [95% CI, −0.02 to 0]; P =0.056). Conclusions: Omega‐3 PUFAs were not associated with increased bleeding risk. Patients receiving high‐dose purified EPA may incur additional bleeding risk, although its clinical significance is very modest.

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  • 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 [127]

    The paper proposes antithrombotic and antiplatelet effects of omega-3 PUFAs as possible explanations for cardiovascular benefit (introductory text and Discussion; page unavailable). It does not specifically connect EPA and DHA’s effects to protection against stroke; its stroke analysis concerns hemorrhagic-stroke bleeding risk. (LLM, conf=0.85)

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Cited by

Sorted by citations

Authors
Javaid, M., Kadhim, K., Bawamia, B., Cartlidge, T., Farag, M., & Alkhalil, M.
Affiliations
Freeman Hospital (GB)
Corresponding author
Alkhalil, Mohammad
ORCID
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2024-05-21
Volume
13
Issue
10
Pages
e032390-e032390
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.123.032390
PMC
PMC11179820
OpenAlex
W4396895496
Cited by
58
References
6
Citations by year
2026: 37 · 2025: 19 · 2024: 2
FWCI
3.41
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
  • Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
Keywords
omega-3 polyunsaturated fatty acids, bleeding risk, eicosapentaenoic acid, hemorrhagic stroke, intracranial hemorrhage, gastrointestinal bleeding, antiplatelet therapy, dose-response relationship, fatal bleeding
MeSH terms
Hemorrhage, Humans, Platelet Aggregation Inhibitors, Risk Factors, Fatty Acids, Omega-3, Randomized Controlled Trials as Topic, Risk Assessment

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