I agreen with previously mentionned opinions. Warfarin is a medication use to prevent serious thrombo-embolic events and considering the mortality and morbidity associated with PE, adequate anticoagulation should be your primary objective for the next six months. Alternatives for you knee should be looked into (possibly topical NSAIDs like Pensaid with little systemic absorption…bitch to put on though).
A quick review of pubmed shows that current evidence seems to suggests, as per a 2007 American Journal of Cardiology paper, that fish oils (omega-3 FA) do not interfere with bleeding time and INR when combined with other anticoagulation / anti-platelet therapies.
However, there are a few case reports of significantly increased INRs when fish oils were added or increased during warfarin treatment. As you might have been told, anticoagulation is a goal, excessive anticoagulation can be deadly in some instances, especially in somebody who is relatively active and is at increased risk for injury.
Of course, your INR will probably be checked regularly until its well stabilized but personally, this is not a risk I would be willing to take at the moment (especially for as short a period as six months).
Good recovery,
AlexH.
Am J Cardiol. 2007 Mar 19;99(6A):35C-43C. Epub 2006 Nov 28. Links
Comment in:
Am J Cardiol. 2007 Mar 19;99(6A):44C-46C.
Safety considerations with omega-3 fatty acid therapy.Bays HE.
Louisville Metabolic and Atherosclerosis Research Center, Louisville, Kentucky 40213, USA. hbaysmd@aol.com
It has been suggested that the potential antithrombotic effect of fish oils may theoretically increase the risk for bleeding, which may be a safety concern for individual patients. However, clinical trial evidence has not supported increased bleeding with omega-3 fatty acid intake, even when combined with other agents that might also increase bleeding (such as aspirin and warfarin). Another potential safety concern is the susceptibility of omega-3 fatty acid preparations to undergo oxidation, which contributes to patient intolerance and potential toxicity. Finally, large amounts of fish consumption may result in adverse experiences due to the potential presence of environmental toxins such as mercury, polychlorinated biphenyls, dioxins, and other contaminants. The risks of exposure to environmental toxins and hypervitaminosis with fish consumption are substantially reduced through purification processes used to develop selected concentrated fish oil supplements and prescription preparations. Thus, in choosing which fish oil therapies to recommend, clinicians should be aware of available information to best assess their relative safety, which includes the US Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) advisory statement regarding fish consumption, the meaning of certain labeling (such as “verification” through the US Pharmacopeia) and the differences in FDA regulatory requirements between nonprescription fish oil supplements and prescription fish oil preparations, and how all of this is important to the optimal treatment of patients.
PMID: 17368277 [PubMed - indexed for MEDLINE]
J Thromb Thrombolysis. 1998 Jul;5(3):257-261.
Effects of Marine Fish Oils on the Anticoagulation Status of Patients Receiving Chronic Warfarin Therapy.Bender NK, Kraynak MA, Chiquette E, Linn WD, Clark GM, Bussey HI.
The University of Texas Health Sciences Center, Division of Pharmacotherapy, San Antonio, Texas, USA.
The purpose of this placebo-controlled, randomized, double-blinded, parallel study was to determine the existence and magnitude of effect of various doses of fish oil supplements on International Normalized Ratio (INR) determinations in patients receiving chronic warfarin therapy. Patients from anticoagulation clinics from both the Brady Green Community Health Center and Audie L. Murphy Veterans Administration in San Antonio, Texas were enrolled in the study. The enrolled subjects included 5 males and 11 females, all of whom were receiving chronic warfarin therapy for indications requiring oral anticoagulation. All enrolled patients underwent a 4-week placebo monitoring period in which INRs were determined on a weekly basis. If the INRs were found to be stable, patients were randomized to receive a 4-week treatment period of either placebo capsules (n = 6), 3 grams of fish oil daily (n = 5), or 6 grams of fish oil daily (n = 5). Patients were followed on a twice-weekly basis for INR determinations and adverse reactions. Five patients were discontinued from the study due to noncompliance (2) and unstable INRs (3). There was no statistically significant difference in INRs between the placebo lead-in and treatment period within each group (P = 0.82). There was also no difference in INRs found between groups (P= 0.41). One bruising episode was reported, yet no major bleeding episodes were observed during the study. Fish oil supplementation in doses of 3-6 grams per day does not seem to create a statistically significant effect on the anticoagulation status of patients receiving chronic warfarin therapy.