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Moderate risk of interaction - Apixaban and fish oil

I got a bit of a shock at this information - thanks to Kingsley09 for the heads up.

drugs.com/drug-interactions...

I’m still researching if there is a safe amount to take with anticoagulants but I’ve taken my last cod liver oil capsule, that’s for sure.

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Hi Finvola :-) it says ''other products containing omega-3 fatty acid'' I am assuming that doesn't mean O3 rich fish which it is recommended we eat 3 times a week something with which I try to comply.

Dr Gupta frequently suggests a mediterranean diet which is rich in O3.

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See my post above...

This is the Eliquis site ...

mobileresourcekit.com/afib/...

see the recommendation of food to eat including oily fish.

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There are warnings about various herbal remedies as well.

dailymail.co.uk/health/arti...

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Doodle - we were just discussing this at dinner! We eat oily fish about three times a week also and it is recommended on practically every AF site you see. Interesting that Eliquis agree with this advice. When i was prescribed Apixaban fish oil was not in the list of things to avoid.

I assume that the reference to moderate interaction may be for large doses which wouldn’t be the case with a piece of salmon or a mackerel but I need to do more reading.

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Hi Finvola :-) I think where obtaining essential vitamins/ dietary requirements is concerned, eating the whole food rather than supplements is almost always preferable because they are not so concentrated and break down better due to the interaction with the other content within the food.

I think with Apixaban being so new, contraindications with other substances has yet to be fully investigated.

I read ginger in combination with Apixaban can also cause problems with platelets in some instances and I eat a lot of ginger but I guess like many things it will only be a problem for a few people but they have to mention it just in case.

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Interested in the original post and the subsequent replies since I eat oily fish a couple of times a week and was initially a bit alarmed. However I don't take fish oil supplements so will just keep watch for the symptoms mentioned in the article. I do that anyway.

In short .... good to know about/be aware of but not a cause for great alarm for most people (IMHO)

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Yes I’m large doses, fish oil, garlic, tumeric can all cause less platelet sticking, and increase the bleed time, anti inflammatory can do the same, but consumed in small amount through normal diet, it shouldn’t be a concern, if you experience extra bruising , consult your doctor, and wisely cut back on the foods, the lady the article talked about was on warfarin and she upped her supplements of fish oil to 2000mgs Instead of 1000mgs which changed her INR once advised to cut back her INR returned to within acceptable limits,

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NICE removed Omacor (Omega-3 supplement) from being recommended for heart attack patients several years before NOACs even appeared, partially due to the same problem with warfarin and partially due to a lack of proof that it actually benefitted the patient.

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Thank you for the replies. I started taking cod liver oil and malt as a toddler in the 1940’s and really didn’t think of it as a supplement, which of course it is.

A portion of salmon contains about 1g oil, so normal dietary intake would be only 2 or 3 grams per week but my intake is about 10g weekly, so that may have contributed to my frequent nosebleeds. I am hoping that stopping the capsules will improve that misery.

I learn something every day!

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Ooooh ... I remember those supplements as a young child in the late '40s/early '50s - and the orange juice too! Seem to remember stopping them when I was about 8?

Were they free and initiated by the then new NHS?

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I think concentrated orange juice and also cod liver oil were free in the late 1940’s, probably as you say, with the start of the NHS. Flat, tall glass bottles as I remember. A

Allen & Hanbury’s made Cod Liver Oil and Malt in dark brown jars - yum - still remember the gloopy, sweet taste. My mother had to hide it and ration it out, otherwise the lot disappeared and she had two sick kids!!

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Ah yes. That's right. I remember going to the clinic with Mum for the orange and cod liver oil but then begging her to get the Malt in the big brown jars 'cos one of my friends had that. As you say ... it had to be doled out sparingly as it was yummy!

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Thanks for this thread!

I’m very interested, partly because I’m pretty sure a lot of people on here do take both a DOAC and a high strength omega 3 supplement, and also because my EP absolutely categorically said I should be taking it. But now I’m wondering...!

In 2012 when I first saw the EP I had a diagnosis of SVT but no documented AF. The EP said the best thing I could do to ward off AF and for general heart health is take Omega 3 fish oil supplement daily.

When AF was discovered and Rivaroxaban started, I saw the warnings and stopped taking my fish oil supplement (tho continued eating lots of sardines and salmon). It wasn’t for another year that I saw the EP again and he was not pleased that I’d stopped the fish oil supplement. He said it’s still the best thing I can take to minimise AF deterioration and improve heart health, and that there’s no problem taking it with anticoagulation. He swapped me to Apixaban because it’s his preferred one, for people like me who have a history of gastric erosion/ulcer.

Strange, isn’t it? I was sure other people on the forum have been told it’s fine to take both... be very interesting to hear if so. :)

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Thank you for that Jane - so confusing isn’t it? I intend to discuss this with my cardiologist in the spring - probably will have a different opinion entirely! I agree, it would be interesting to hear the different advice which members have been given.

I’ve been told that my nosebleeds are a side effect of anticoagulation as well as sensitivity to solvents, so I’m very keen to review anything which adds to that effect. Interestingly, several bleeds may have been started by a steroid nasal spray which I was told I must use - ENT consultant told me not to use it!!

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Good grief, sometimes it feels like not much more than guesswork?! How do we ever know what’s best?! :)

Grateful if you’d let me know if you get any further advice from your cardiologist - or anyone. Xx

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Will do Jane. xx

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Hi I’m just wondering if anyone it taking turmeric for pain relief as I read it is a blood thinner and I’m on apixaban but turmeric use to help with my pain relief but now I’m on apixaban I’m not taking it and now of course my pain is really bad but a friend of mine said surely there are people of Indian countries who are on apixaban and do they stop using it in there cooking if they are on apixaban so I was wondering if there are any people out there that can let me know the answer to that thanks

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There is a post from Hertbeat321 earlier in the thread mentioning turmeric as having anti platelet effects too. It would probably be best to discuss this with your pharmacist or GP.

You have my thanks for raising the issue of fish oil and Apixaban in your earlier posts. xx

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Omega 3 has so many health benefits I take 1000mg daily along with my Eliquis and other supplements. You can research til the cows come home and you will find oodles of no's and yes's on the subject. Let's face it, I take a drug prescribed by a doctor that can cause me to have a bleed , a hemorrhagic stroke, or a PE (which I have suffered while take Xarelto) If I fall and injured myself I can bleed to death. If I'm in a motor accident and am injured , good luck if the ambulance gets there before I bleed out,so I make up my own mind on what I think is safe for me. So far so good. I cant tell you what to take but read read read. The research you should be looking for should be current...not from years ago. And you need to check how many people were involved in the trial and for how long.

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