NutriStack
Fish Oil and Rivaroxaban, a caution.
Fish oil has antiplatelet and antithrombotic properties that may increase bleeding risk when combined with rivaroxaban. The combination creates additive hemostatic impairment through different mechanisms. Higher fish oil doses pose greater 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
- Fish Oil and Rivaroxaban
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 4 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Fish oil has antiplatelet and antithrombotic properties that may increase bleeding risk when combined with rivaroxaban. The combination creates additive hemostatic impairment through different mechanisms. Higher fish oil doses pose greater risk.
Mechanism. EPA and DHA inhibit platelet aggregation by reducing thromboxane A2 production and altering platelet membrane fluidity. Combined with rivaroxaban's Factor Xa inhibition, the dual antiplatelet-anticoagulant effect increases overall bleeding risk.
Recommendation. Low-to-moderate dose fish oil (1-2g/day) can generally be used with rivaroxaban under medical supervision. Avoid doses above 3g/day. Monitor for signs of increased bleeding.
Sources (4)
- Bays HE. Safety considerations with omega-3 fatty acid therapy. Am J Cardiol. 2007;99(6A):35C-43C. PMID 17368277
- Liao Y, Xie B, Zhang H et al.. Efficacy of omega-3 PUFAs in depression: A meta-analysis.. Translational Psychiatry. 2019. PMID 31383846
- Wei BZ, Li L, Dong CW et al.. The Relationship of Omega-3 Fatty Acids with Dementia and Cognitive Decline: Evidence from Prospective Cohort Studies of Supplementation, Dietary Intake, and Blood Markers.. American Journal of Clinical Nutrition. 2023. PMID 37028557
- Uchida Y, Tsuji K, Ochi E. Effects of Omega-3 fatty acids supplementation and resistance training on skeletal muscle.. Clinical Nutrition ESPEN. 2024. PMID 38777432
Stack Score
How this pair moves the number.
Effect on the composite score
If both Fish Oil and Rivaroxaban 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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