CASE REPORT and REVIEW - Subdural hematoma after a fall in an elderly patient taking high-dose omega-3 fatty acids with warfarin and aspirin

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Pharmacotherapy. 2007 Jan;27(1):152-60.

Subdural hematoma after a fall in an elderly patient taking high-dose

omega-3 fatty acids with warfarin and aspirin: case report and review

of the literature.

McClaskey EM, Michalets EL.

University of North Carolina-Chapel Hill School of Pharmacy, Chapel

Hill, North Carolina, USA.

The elderly population is at an increased risk for major bleeding,

possibly due to increased sensitivity to anticoagulation, multiple

comorbidities, and polypharmacy. Elderly patients receiving

antiplatelet and anticoagulant therapy have an additional risk for

bleeding. Omega-3 fatty acids, also known as fish oil, have been used

for hyperlipidemia, coronary heart disease, hypertension, and other

conditions. Some studies have demonstrated that consumption of fish

oil concentrate, n-3 polyunsaturated fatty acid (n-3 PUFA), results in

cardiovascular benefits that include reductions in mortality, sudden

death, nonfatal myocardial infarction, and thrombotic stoke, as well

as improvement in graft patency. The mechanism of action of n-3 PUFA

is not completely understood, but a dual antiplatelet and

anticoagulant effect has been proposed. Few data exist on whether or

not fish oil can be used safely with other antiplatelet or

anticoagulant drugs. We report the case of a patient who after a minor

fall developed a subdural hematoma requiring craniotomy that likely

was precipitated by concomitant use of high-dose omega-3 fatty acids 6

g/day with both aspirin and warfarin. These findings are important

because of the wide availability of omega-3 fatty acids and the

propensity for use of complementary and alternative medicine in

patients with cardiovascular disease who are already taking

antiplatelet and/or anticoagulant agents. Judicious use of these

combinations is advised, and pharmacists can play an important role in

educating patients and other health care providers about the bleeding

risks associated with combination therapy.

PMID: 17192169

http://www.ncbi.nlm.nih.gov/pubmed/17192169

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