Perioperative bleeding: omega-3-rich fish oil is safe and reduces the number of transfusions needed
Fish oil supplements do not promote postoperative bleeding in cardiac surgery patients; in fact, they reduce the number of blood transfusions needed after surgery. These new findings support the need to reconsider current recommendations that advise against the use of omega-3 supplements before cardiac surgery because they are believed to cause bleeding.
This was discovered by researchers at the Sanford School of Medicine at the University of South Dakota (USA), and published in the journal Circulation last month. In fact, there is no significant scientific evidence associating uncontrolled bleeding with the use of omega-3 supplements. Some studies in recent years, however, have shown otherwise; such as a systematic review published in the Danish Medical Journal, which looked at data from 16 studies of patients undergoing surgery and showed that fish oil supplements did not increase the risk of bleeding or blood loss (https://www.omegor.com/blog-omega-3/speciali-omega-3/omega-3-operazioni-chiururgiche/emorragia-chirurgica-integratori-olio-pesce-non-aumentano-rischio-sanguinamento/).
In addition, although EPA has been shown to have anticoagulant power, there is no firm evidence for its role in the surgical setting.
Omega-3 supplements do not cause bleeding for patients undergoing cardiac surgery
In the new study, researchers conducted a secondary analysis using data from a previous large-scale study, named OPERA, conducted to study the role of omega-3s in the onset of atrial fibrillation in the postoperative period. The number of hemorrhages and blood units needed for transfusion was one of the secondary findings, which emerged from this research. The results showed that supplementation with fish oil supplements has no effect on postoperative atrial fibrillation, but surprisingly other data showed a significant reduction in the number of blood units needed for transfusion, and that the higher the level of EPA and DHA in the blood on the morning of surgery, the lower the risk of bleeding for the operated patient.
According to the researchers, these new findings support the need to reconsider current recommendations suggesting that fish oil consumption should be discontinued before cardiac surgery, according to Professor Bill Harris, co-inventor of theOmega-3 Index. The Omega-3 Index is a parameter that expresses the percentage of EPA and DHA to total fatty acids in red blood cells, and is a stable long-term indicator of omega-3 status that accurately reflects an individual's EPA and DHA levels. An omega-3 index between 8% and 12% is considered the optimal range for reducing cardiac risk.
Some details of the study
The OPERA study included 1,516 patients, with a mean age of 63 years, who underwent cardiac surgery that included coronary artery and valve bypass grafting. The patients were randomly divided into two groups, which either received omega-3 or a placebo substance. Going into detail: the treatment group received high doses of EPA and DHA (6.5 to 8 grams total) two to five days before surgery, and then were given 1.7 grams of omega-3 on the morning of surgery. Dosage maintenance continued until the patients were discharged.
The primary outcome of the OPERA study was to see if these acute omega-3 dosages reduced the risk of postoperative atrial fibrillation, an unpleasant and potentially dangerous complication from surgery. The study found no effect in this regard. However, Harris's team also examined bleeding criteria data and identified the number of units of blood needed for transfusions in the operated patients, finding not only that the higher the level of EPA and DHA in the blood on the morning of surgery, the lower the risk of bleeding, but also a significant reduction in the number of units of blood used for transfusions in the patients who had taken omega-3, compared with the placebo group.
Bleeding measurements were made using a small razor blade to make cuts in the arm, and consider the time required for coagulation. As Harris himself stated, this evidence does not correlate with the complexity of cardiac surgery, where the cuts are large and the role of inflammation is not well understood, and thus needs further study.
Fish oil is safe and there is no need to stop supplementation before surgery
According to the researchers, the recent study shows that fish oil supplements do not increase bleeding in the postoperative stages and reduce the number of blood transfusions. In addition, higher levels of omega-3 were found to be associated with a lower risk of bleeding. These new findings support the need to reconsider current recommendations to discontinue omega-3 supplementation near surgery, although their role in coagulation needs further investigation.
Source: Emmanuel Akintoy, et al. "Fish Oil and Perioperative Bleeding.Insights From the OPERA Randomized Trial." Circulation.
