From the Guidelines
Fish oil does not exacerbate bleeding in patients taking Selective Serotonin Reuptake Inhibitors (SSRIs).
Rationale
- The effect of fish oil on platelet aggregation is well-documented, but studies have shown that this effect does not increase bleeding risk during or after surgery in Randomized Controlled Trials (RCTs) 1.
- While omega-3 fatty acids (fish oil) have been shown to inhibit platelet-to-platelet adhesion and platelet-stimulated thrombin generation in vitro, a large placebo-controlled trial found no increase in perioperative bleeding in patients taking fish oil versus placebo 1.
- The available evidence suggests that the risk of bleeding associated with fish oil is minimal, and it is unlikely to exacerbate bleeding in patients taking SSRIs.
Key Points
- Fish oil reduces platelet aggregation, but this effect does not increase bleeding risk.
- Omega-3 fatty acids inhibit platelet-to-platelet adhesion and platelet-stimulated thrombin generation in vitro.
- No increase in perioperative bleeding was found in patients taking fish oil versus placebo in a large placebo-controlled trial 1.
From the Research
Interaction between Fish Oil and SSRIs
- There is no direct evidence in the provided studies to suggest that fish oil exacerbates bleeding in patients taking Selective Serotonin Reuptake Inhibitors (SSRIs) 2, 3, 4, 5, 6.
- However, the studies do suggest that SSRIs may increase the risk of bleeding due to their effect on platelet function and serotonin levels 3, 4, 5.
Bleeding Risk associated with SSRIs
- The risk of bleeding with SSRI treatment appears to be low, but it does exist and must be considered in patients who develop abnormal bleeding or bruising 2.
- SSRIs can result in decreased storage of serotonin in platelet dense granules, which can affect platelet aggregation and increase the risk of bleeding 4.
- The use of SSRIs in combination with other medications that affect platelet function, such as NSAIDs or anticoagulants, may increase the risk of bleeding 3, 4, 5.
Clinical Implications
- Patients taking SSRIs should be monitored for signs of bleeding, particularly those with preexisting bleeding risks or taking other medications that affect platelet function 2, 3, 5.
- The decision to stop SSRIs before surgery should be made after a complete discussion of the risks and benefits, particularly in psychologically vulnerable patients 6.