Should Lovaza (omega-3-acid ethyl esters) be stopped prior to surgery?

Perioperative Management of Lovaza (Omega-3-Acid Ethyl Esters)

Lovaza (omega-3-acid ethyl esters) does not need to be discontinued before surgery as it does not significantly increase perioperative bleeding risk.

Evidence on Omega-3 Supplements and Perioperative Bleeding

• Omega-3 fatty acid supplementation does not increase perioperative bleeding risk and has actually been shown to reduce the number of blood transfusions needed in cardiac surgery patients 1
• Unlike anticoagulants (warfarin), antiplatelet agents (aspirin, clopidogrel), or NSAIDs that require specific preoperative discontinuation, omega-3 supplements do not appear in guidelines as medications requiring interruption before surgery 2
• A multinational, placebo-controlled trial involving 1516 patients demonstrated that fish oil supplementation did not increase perioperative bleeding risk, even at high preoperative doses (8-10g for 2-5 days) 1
• Higher achieved plasma omega-3 polyunsaturated fatty acid levels were actually associated with lower risk of bleeding in surgical patients 1

Comparison with Other Medications Requiring Discontinuation

• Anticoagulants like warfarin typically need to be stopped 5-6 days before surgery 2, 3
• Antiplatelet medications such as aspirin and clopidogrel should be discontinued 7-10 days before surgery in most cases 2, 3
• NSAIDs require varying discontinuation periods ranging from 1-10 days depending on the specific agent 3
• Unlike these medications, omega-3 supplements like Lovaza do not have specific discontinuation recommendations in perioperative guidelines 2

Potential Benefits of Continuing Omega-3 Supplements

• Omega-3 fatty acids may actually provide protective effects in the perioperative period:
  • Reduced need for blood transfusions in cardiac surgery patients 1
  • Decreased risk of postoperative deep vein thrombosis and pulmonary embolism in elderly patients with proximal femoral fractures 4
  • Reduction in liver volume before bariatric surgery, potentially improving surgical access 5

Practical Recommendations

• Continue Lovaza (omega-3-acid ethyl esters) throughout the perioperative period 2, 1
• Include omega-3 supplements in the medication history during preoperative assessment to ensure they are not mistakenly discontinued 6
• Monitor for any unusual bleeding, although clinical evidence suggests this is not a significant concern 1
• Consider the potential benefits of continued omega-3 supplementation, including possible reduction in thrombotic events 4

Common Pitfalls to Avoid

• Unnecessarily discontinuing omega-3 supplements like Lovaza before surgery due to theoretical bleeding concerns that are not supported by evidence 1
• Failing to distinguish between medications that truly increase bleeding risk (anticoagulants, antiplatelets, NSAIDs) and those that do not (omega-3 supplements) 2, 3
• Delaying elective procedures for patients taking fish oil supplements, which current evidence suggests is unnecessary 1