NutriStack
Enoxaparin and Fish Oil, a caution.
Fish oil's omega-3 fatty acids reduce platelet thromboxane A2 and prolong bleeding time. Added to enoxaparin's anti-factor Xa activity, high-dose fish oil (more than 3 g/day EPA+DHA) can additively raise bleeding risk, particularly around surgery or invasive procedures.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Enoxaparin 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 prolong bleeding time. Added to enoxaparin's anti-factor Xa activity, high-dose fish oil (more than 3 g/day EPA+DHA) can additively raise bleeding risk, particularly around surgery or invasive procedures.
Mechanism. EPA and DHA displace arachidonic acid in platelet membrane phospholipids, reducing thromboxane A2 generation and platelet aggregation. This pharmacodynamic effect is additive to enoxaparin's anti-factor Xa anticoagulation.
Recommendation. Keep fish oil dose modest (≤2 g/day combined EPA+DHA) while on enoxaparin and keep the dose constant. Stop fish oil at least 7 days before any planned procedure 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 Enoxaparin 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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