Cardiovascular Quality and Outcomes. 2018;11:e004584
Emmanuel Akintoye , Prince Sethi , William S. Harris , Paul A. Thompson , Roberto Marchioli , Luigi Tavazzi , Roberto Latini , Mias Pretorius , Nancy J. Brown , Peter Libby , Dariush Mozaffarian
- Patients are typically told to stop taking Omega–3 supplements before surgery
- Trail had patients take 8-10 grams/day before surgery and 2 grams/day after, or placebo
- Note: The pre-surgery dosing was ~4X higher than normal dosing
- Overall 1% lower risk of bleeding by group getting the Omega-3
- Those with the highest Omega-3 test results had a 64% less chance of bleeding
- Transfusion blood used: Placebo 1.8 units; Omega-3 1.6 units
- Omega-3 RDAs around the world: 100 to 2400 mg per day, US still has no RDA – Dec 2018
- Omega-3 proven to provide many benefits in 5 year VITAL trial - Nov 2018
- Omega-3 index - good level needed 2.4 grams of regular Omega-3 - Grassroots Nov 2018
- I use Vectomega brand of Omega-3 – Admin of VitaminDWiki, May 2014
Vitamin D and Omega-3 category starts with
- Omega-3 reduced pancreas transplant failure by 3X and sepsis by 2X – review Dec 2019
- Hospitalization costs reduced ~3,000 dollars when intravenous nutrition was augmented with Omega-3 – Aug 2019
- Omega-3 supplements taken before and after surgery actually helped – RCT Nov 2018
- ICU length of stay reduced when supplement with Omega-3 – meta-analysis July 2018
- 3 days of Omega-3 before cardiac surgery reduced risk of post-op bleeding by half – RCT March 2018
- Omega-3 benefits in surgery and ICU including via IV - March 2016
- Omega-3 reduced time in hospital and atrial fibrillation after cardiac surgery – meta-analysis May 2016
- 2.7 fewer days in hospital after surgery if had taken Omega-3 (19 RCT) – meta-analysis – June 2017
- Sepsis: 4 fewer days in ICU if add Omega-3 – meta-analysis of 12 RCT – June 2017
- Cognitive decline after traumatic brain injury reduced by Omega-3 (mice) – Nov 2016
- Football Brain injuries prevented by Omega-3 – RCT Jan 2016
- Omega-3 should be cost-effective to reduce days in ICU – simulation June 2015
Fish oil is among the most common natural supplements for treatment of hypertriglyceridemia or prevention of cardiovascular disease. However, concerns about theoretical bleeding risk have led to recommendations that patients should stop taking fish oil before surgery or delay in elective procedures for patients taking fish oil by some health care professionals.
Methods and Results
We tested the effect of fish oil supplementation on perioperative bleeding in a multinational, placebo-controlled trial involving 1516 patients who were randomized to perioperative fish oil (eicosapentaenoic acid+docosahexaenoic acid; 8–10 g for 2–5 days preoperatively, and then 2 g/d postoperatively) or placebo.
Primary outcome was major perioperative bleeding as defined by the Bleeding Academic Research Consortium.
Secondary outcomes include perioperative bleeding per thrombolysis in myocardial infarction and International Society on Thrombosis and Hemostasis definitions, chest tube output, and total units of blood transfused. Participants’ mean (SD) age was 63 (13) years, and planned surgery included coronary artery bypass graft (52%) and valve surgery (50%). The primary outcome occurred in 92 patients (6.1%).
Compared with placebo, risk of Bleeding Academic Research Consortium bleeding was not higher in the fish oil group: odds ratio, 0.81; 95% CI, 0.53–1.24; absolute risk difference, 1.1% lower (95% CI, −3.0% to 1.8%).
Similar findings were seen for secondary bleeding definitions. The total units of blood transfused were significantly lower in the fish oil group compared with placebo (mean, 1.61 versus 1.92; P<0.001).
Evaluating achieved plasma phospholipid omega-3 polyunsaturated fatty acids levels with supplementation (on the morning of surgery), higher levels were associated with lower risk of Bleeding Academic Research Consortium bleeding, with substantially lower risk in the third (odds ratio, 0.30 [95% CI, 0.11–0.78]) and fourth (0.36 [95% CI, 0.15–0.87]) quartiles, compared with the lowest quartile.
Fish oil supplementation did not increase perioperative bleeding and reduced the number of blood transfusions. Higher achieved n-3-PUFA levels were associated with lower risk of bleeding. These novel findings support the need for reconsideration of current recommendations to stop fish oil or delay procedures before cardiac surgery.
Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00970489.
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