NutriStack
Dabigatran and Fish Oil, a caution.
Fish oil's omega-3 fatty acids reduce platelet thromboxane A2 and can prolong bleeding time. Added to dabigatran's direct thrombin inhibition, high-dose fish oil (more than 3 g/day EPA+DHA) can additively raise bleeding risk.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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From the interaction database
What the row says.
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At a glance
- Substances
- Dabigatran and Fish Oil
- Pair type
- Caution
- Evidence (highest tier)
- Emerging
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Emerging evidence
Caution
What is happening. Fish oil's omega-3 fatty acids reduce platelet thromboxane A2 and can prolong bleeding time. Added to dabigatran's direct thrombin inhibition, high-dose fish oil (more than 3 g/day EPA+DHA) can additively raise bleeding risk.
Mechanism. EPA and DHA displace arachidonic acid in platelet membrane phospholipids, reducing thromboxane A2 generation and platelet aggregation. They may also slightly reduce factor VII. This adds to dabigatran's thrombin inhibition.
Recommendation. Keep fish oil dose modest (≤2 g/day combined EPA+DHA) on dabigatran and keep the dose constant. Stop fish oil at least 7 days before any planned surgery and tell your prescriber if you notice unusual bruising or bleeding.
Sources (2)
- Buckley MS, Goff AD, Knapp WE. Fish oil interaction with warfarin. Ann Pharmacother. 2004;38(1):50-2. PMID 14742793
- Watson PD, Joy PS, Nkonde C, Hessen SE, Karalis DG. Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel--versus--aspirin + clopidogrel in patients with cardiovascular disease. Am J Cardiol. 2009;104(8):1052-4. PMID 19801023
Stack Score
How this pair moves the number.
Effect on the composite score
If both Dabigatran and Fish Oil are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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