Management of Omega-3 Supplements Before Surgery

Fish oil/omega-3 fatty acid supplements should be continued up to the day of surgery as they do not increase perioperative bleeding risk. 1

Omega-3 Supplements and Bleeding Risk

Fish oil supplements have previously been a concern for surgical procedures due to theoretical bleeding risks, but recent evidence shows they can be safely continued before surgery 1, 2
The Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement explicitly recommends that fish oil/omega-3 fatty acid preparations should be continued until surgery 1
Prior concerns about bleeding risk with omega-3 supplements have not been supported by prospective clinical studies 2
A large multinational, placebo-controlled trial of 1516 patients found that fish oil supplementation did not increase perioperative bleeding and actually reduced the number of blood transfusions required 2

Multiple surgical specialties have demonstrated the safety of continuing omega-3 supplements:
- In cardiac surgery, higher achieved omega-3 polyunsaturated fatty acid levels were associated with lower risk of bleeding 2
- In spinal decompression surgery, no increase in intraoperative blood loss or postoperative bleeding complications was found with preoperative use of omega-3 supplements 3
- In radical prostatectomy, omega-3 supplementation showed no clinically significant effect on perioperative bleeding, laboratory tests, or postoperative complications 4
- In spinal arthrodesis procedures, omega-3 fatty acid use did not contribute to higher perioperative blood loss 5

While omega-3 supplements can be continued, many other supplements should be discontinued before surgery due to potential bleeding risks 1
Supplements that should be held for 2 weeks before surgery due to bleeding risk include: aloe, arnica, boldo, bromelain, cat's claw, danshen, devil's claw, dong quai, evodia, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng (American, Panax, and Siberian), guarana, horse chestnut, policosanol, resveratrol, saw palmetto, turmeric, vanadium, and vitamin E 1

Unlike many other supplements, omega-3 fatty acids can be safely continued through the perioperative period 1
For patients taking omega-3 supplements, there is no need to discontinue them before surgery 1, 2
The physiological effects of omega-3 fatty acids (increased bleeding time, decreased platelet aggregation, decreased blood viscosity) have not translated to clinically significant bleeding in surgical settings 6
Continuing omega-3 supplements may even be beneficial as they have anti-inflammatory properties that could potentially support recovery 1

Some guidelines suggest that immune-modulating supplements including omega-3 fatty acids can be administered for five to seven days preoperatively in certain surgical populations 1
In cancer patients undergoing major abdominal surgery, preoperative immune-modulating supplements (including omega-3 fatty acids) can reduce postoperative morbidity and length of stay 1

While omega-3 supplements are generally safe to continue, the decision should always be communicated to the surgical team to ensure all providers are aware of the patient's supplement use 1