S
Stuart
Can eating too much fish cause bleeding problems for someone on Coumadin?
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Ross
Well-known member
I highly doubt that you could eat enough fish to make a difference, but then again, what are you considering to be too much?
All other things being equal: No.
If it were me, depending on the type of fish, I'd be far more concerned about mercury content - and I'm not very concerned about that.
Best wishes,
If it were me, depending on the type of fish, I'd be far more concerned about mercury content - and I'm not very concerned about that.
Best wishes,
S
Stuart
Ross said:
I've been eating fish about five meals a week recently, mostly fresh salmon, and I wonder whether it's wise to continue. The reason that I was concerned, was that I remember reading somewhere that Omega-3 supplements are not recommended in combination with Warfarin. I just thought that the Omega-3 in fish is the same thing.
K
Karlynn
Stuart said:
Dose the diet, don't diet the dose.
If this is going to be your regular diet then you will adjust your dose accordingly. Fresh Salmon - yummy!
S
Stuart
Karlynn said:Dose the diet, don't diet the dose.
If this is going to be your regular diet then you will adjust your dose accordingly. Fresh Salmon - yummy!
The problem with omega-3 in fish, as in aspirin, is that the anti-coagulation effect doesn't show up in the INR of a PT test, because it works on the blood platelets rather then the prothrombin, if I understand correctly. So it isn't possible to know how to adjust the dose by the INR value.
K
Karlynn
This article from Al's website, www.warfarinfo.com, would lead me to think that it does register in the INR.
Warfarin Institute of America
Dedicated To Your Health
THE INTERACTION BETWEEN FISH OIL AND WARFARIN
Also known as: Omega-3 polyunsaturated fatty acid
Buckley et al report a case where a woman was taking warfarin and fish oil. Her INR was stable until she doubled the dose of the fish oil. The INR increased from 2.8 to 4.3. The warfarin dose was decreased. She then decreased her fish oil dose to the previous level and the INR went down to 1.6. When the fish oil dose was kept at the same level as before, the warfarin dose was returned to the same level.
This case illustrates how much we do not know yet about the things that affect warfarin. It is prudent to check the INR shortly after making any change to other medications, prescription or not, because they may affect the warfarin dosage.
Holbrook et al published a systematic review of things that interact with warfarin. They rate it as highly probable that the INR will increase, necessitating a lower warfarin dose when someone taking warfarin adds fish oil to their medications.
Reference:
Buckley MS et al. Fish oil interaction with warfarin. Ann Pharmacother. 2004;38:50-2.
Holbrook AM et al. Systematic Overview of warfarin and its drug and food interactions. Arch Intern Med 2005;165:1096-1106.
Warfarin Institute of America
Dedicated To Your Health
THE INTERACTION BETWEEN FISH OIL AND WARFARIN
Also known as: Omega-3 polyunsaturated fatty acid
Buckley et al report a case where a woman was taking warfarin and fish oil. Her INR was stable until she doubled the dose of the fish oil. The INR increased from 2.8 to 4.3. The warfarin dose was decreased. She then decreased her fish oil dose to the previous level and the INR went down to 1.6. When the fish oil dose was kept at the same level as before, the warfarin dose was returned to the same level.
This case illustrates how much we do not know yet about the things that affect warfarin. It is prudent to check the INR shortly after making any change to other medications, prescription or not, because they may affect the warfarin dosage.
Holbrook et al published a systematic review of things that interact with warfarin. They rate it as highly probable that the INR will increase, necessitating a lower warfarin dose when someone taking warfarin adds fish oil to their medications.
Reference:
Buckley MS et al. Fish oil interaction with warfarin. Ann Pharmacother. 2004;38:50-2.
Holbrook AM et al. Systematic Overview of warfarin and its drug and food interactions. Arch Intern Med 2005;165:1096-1106.
The effects of salmon oil at reasonable doses on coagulation are considerably less than those of aspirin, which is often dosed along with warfarin. The benefits of omega 3 oil are more in helping to regulate the rhythm of the heart than in anticoagulation.
Also, the article above seems to show that you can regulate it with your INR, so you can "dose the diet." It doesn't say how much omega 3 the woman was taking, but she must have been taking a hefty amount, and it must have been in capsule form. She was not getting it from natural sources at natural levels.
Regardless, the amount you get from your meal is probably considerably less than one gram, vs. the two-gram dose which is frequently used in studies. The oil in a filet is mostly found in the dark, fatty areas and in the fat along the skin. Both of those are areas most people avoid, because they contain other fats people don't want, and because they have the highest concentrations of any contaminants the fish has ingested. Note that farmed salmon has higher contaminant levels than wild salmon.
I take two grams of virgin wild salmon oil a day, along with garlic, 162 mg aspirin (reduces platelet bonding), and nattozime (an anticoagulant found in natto, which works by cleaning up loose fibrin), although I am not on Coumadin. All are supposed to make blood less able to coagulate, but I still don't bruise any more easily than before or bleed longer or more freely, as far as I can see.
Five meals of salmon a week will probably get to be too much of a good thing after a while anyway, so the question may become moot over time.
Best wishes,
Also, the article above seems to show that you can regulate it with your INR, so you can "dose the diet." It doesn't say how much omega 3 the woman was taking, but she must have been taking a hefty amount, and it must have been in capsule form. She was not getting it from natural sources at natural levels.
Regardless, the amount you get from your meal is probably considerably less than one gram, vs. the two-gram dose which is frequently used in studies. The oil in a filet is mostly found in the dark, fatty areas and in the fat along the skin. Both of those are areas most people avoid, because they contain other fats people don't want, and because they have the highest concentrations of any contaminants the fish has ingested. Note that farmed salmon has higher contaminant levels than wild salmon.
I take two grams of virgin wild salmon oil a day, along with garlic, 162 mg aspirin (reduces platelet bonding), and nattozime (an anticoagulant found in natto, which works by cleaning up loose fibrin), although I am not on Coumadin. All are supposed to make blood less able to coagulate, but I still don't bruise any more easily than before or bleed longer or more freely, as far as I can see.
Five meals of salmon a week will probably get to be too much of a good thing after a while anyway, so the question may become moot over time.
Best wishes,
I didn't think that eating fish was the same as consuming Omega 3 fatty acid via supplements. Supplements are more concentrated sources.
C
Curtsmum
Dont want to steal this thread but i give my son omega 3 fish oil capsules now, will this fit in when he takes warfarin or do i stop giving it to him now
G
Georgia
Consistency is the word here - I believe it's been found that there's no problem with inr if omega-3 is taken consistently and when coumadin is begun. The problem arises when it's taken on and off.
Like many other things . . .
Like many other things . . .
I agree with Georgia. Consistency is key with warfarin. The woman in the vignette doubled her dose, and it couldn't have been a small dose to begin with.
If he stays on his dose, you will automatically dose the diet. If he has to go off of it, and you want to put him back on, start it up slowly and work up gradually.
Best wishes,
If he stays on his dose, you will automatically dose the diet. If he has to go off of it, and you want to put him back on, start it up slowly and work up gradually.
Best wishes,
My husband is on coumadin and takes 2 fish oil pills a day per his doctor and has since the 1st month he started the coumadin. I think consistency(SP) is the key. He has been pretty stable in his INR with only a few bumps in the road. He has been high a few times but never low in the four years since he was regulated.
