Blood clotting, or coagulation, is a necessary process that prevents excessive bleeding when an injury to the blood vessel occurs. When functioning correctly, the body will naturally dissolve the blood clot after healing the wound. However, clots can become dangerous if they do not dissolve or if clots are formed without proper reason. According to the American Society of Hematology, blood clots are among the most preventable blood conditions.
Several medications and supplements on the market today act as anticoagulants and blood thinners and can reduce the risk of harmful blood clots. If you already take an anticoagulant like Eliquis, you may be wondering if an alternative, like fish oil, can provide similar benefits. Before making any decisions, keep reading to learn more about the similarities and differences between these two therapies.
What is Eliquis?
Also known as Apixaban, Eliquis is an oral anticoagulant that acts as a factor Xa inhibitor. Factor Xa is a catalyst for converting prothrombin to thrombin, which leads to fibrin and clot formation. Only available with a doctor’s prescription, this medication decreases the body’s blood clotting ability and helps prevent them from forming.
According to the National Institutes of Health, Eliquis is a prescription medication used to:
- Reduce the risk of stroke and blood clots in people who have nonvalvular atrial fibrillation
- Reduce the risk of forming a blood clot in the legs and lungs of people who have had hip or knee replacement surgery and cannot walk for a period of time
- Treat blood clots in the veins of your legs (deep vein thrombosis) or lungs (pulmonary embolism) and reduce the risk of recurrence
What are the Benefits of Taking Eliquis?
Clinical trials using Eliquis have been mixed, and the benefits appear to depend on certain underlying clinical conditions.
Atrial Fibrillation
Several studies have been performed to evaluate the efficacy of Eliquis in patients with atrial fibrillation. For example, the AVERROES Trial found that Eliquis was superior to aspirin in reducing the risk of stroke or systemic embolism in patients with atrial fibrillation without a significant increase in the risk of major bleeding.
Another study — the ARISTOTLE Trial — concluded that Eliquis was superior to warfarin in reducing the risk of stroke or systemic embolism in patients with atrial fibrillation and was also associated with a lower risk of bleeding compared with warfarin. Another 2022 study compared the effectiveness of Xarelto (another popular anticoagulant) and Eliquis in patients with atrial fibrillation and found that those treated with Xarelto were at significantly increased risk of major ischemic or hemorrhagic events compared with Eliquis.
Venous Thromboembolism (VTE)
Researchers have investigated the effects of Eliquis on both the prevention and treatment of venous thrombosis. Regarding prevention, the APROPOS Trial concluded that Eliquis might effectively prevent VTE after total knee replacement.
The ADOPT Trial failed to demonstrate effectiveness in preventing VTE using Eliquis, and bleeding rates were significantly higher compared with Lovenox. However, the ADVANCE-2 and ADVANCE-3 trials found Eliquis was superior to Lovenox for preventing VTE in patients undergoing hip replacement surgery.
Furthermore, the AMPLIFY-EXT Trial found that Eliquis, given for 12 months following standard anticoagulant therapy, was superior to placebo in reducing recurrent VTE without an increased risk of major bleeding events. Therefore, evidence indicates that Eliquis may be an appropriate and effective therapy for treating and preventing blood clots for those with atrial fibrillation and VTE. However, like most prescription medications, Eliquis does come with some risks.
What are the Risks of Taking Eliquis?
As an anticoagulant, the most common adverse effect is bleeding. Minor bleeding, such as nosebleeds or gum bleeding, is commonly reported. Although major bleeds are less common, it is recommended that while taking Eliquis, that you avoid activities that may increase the risk of injury.
Furthermore, the concomitant use of drugs affecting blood properties, including over-the-counter or prescription blood thinners, antiplatelets, anticoagulants, thrombolytic agents, and non-steroidal anti-inflammatory drugs (NSAIDs), should be discussed with a medical provider beforehand and monitored judiciously. Additional considerations when taking Eliquis include the high cost and contraindications such as pregnancy.
What is Fish Oil?
Fish oil is a common dietary source of omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Available as a dietary supplement or prescription from a medical provider, omega-3s are essential components of the membranes surrounding each cell in the body and are necessary for normal physiological functioning.
Scientists studying omega-3 consumption have uncovered several health benefits of fish oil and omega-3 intake related to eye health, infant growth and development, allergies and autoimmune disease, cognition, and cardiovascular disease.
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Evidence from human studies suggests that the beneficial effects of omega-3s on cardiovascular disease rely, at least partly, on their antiplatelet action, specifically helping to reduce the risk of blood clots under certain circumstances. Dietary recommendations for EPA and DHA are between 250 and 500mg/day based on cardiovascular risk considerations. However, 5g/day dosages have been reported with no adverse side effects.
What are the Benefits of Taking Fish Oil?
Several studies have demonstrated the benefits of omega-3 intake on cardiovascular disease and blood clotting risk. A 2014 population-based study found that high weekly fish intake was associated with a 22% lower risk of VTE than those who consumed no fish and no omega-3 supplementation. Adding fish oil supplements strengthened the inverse effect, leading to a 48% lower risk of VTE.
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Another study conducted in healthy males found that 3g of fish oil supplementation daily for four weeks reduced plasma triglycerides and lowered platelet integrin activation. Furthermore, A 2013 meta-analysis of 15 studies found that omega-3 supplementation significantly reduced platelet aggregation (a predictor of adverse cardiovascular events) when participants were in poor health, leading researchers to conclude that those with cardiovascular disease or diabetes may benefit most from omega-3 therapy. Therefore, receiving adequate amounts of omega-3 fatty acids DHA and EPA in the diet can provide cardiovascular benefits such as reducing the risk of blood clotting for both healthy and diseased populations.
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What are the Risks of Taking Fish Oil?
Fish oil supplements are generally considered safe when taken as recommended. Generally, 2-4g of EPA + DHA daily is needed to provide the full antiatherosclerotic, anti-inflammatory, and antiplatelet benefits. Although evidence indicates that omega-3 intake reduces clotting, current literature suggests no additional bleeding risks exist. Some mild reported side effects include fishy aftertaste, heartburn, nausea, or upset stomach.
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However, omega-3 fatty acids may potentiate the pharmacologic effects of anticoagulants and other drugs that affect blood properties, such as platelet inhibitors and NSAIDs. Although risk appears to be very low, the U.S. Food and Drug Administration recommends consuming no more than 5g/day of EPA and DHA unless under the care of a medical provider. Furthermore, omega-3s should not be added to other anticoagulant therapies unless under the supervision of a medical provider due to possible nutrient-drug interactions.
Can you Take Fish Oil Instead of Eliquis?
The short answer is no. Fish oil is not a substitute for Eliquis. Blood coagulation is complex; platelet activation, aggregation, and fibrin generation are crucial. Fish oil, like aspirin, acts as an antiplatelet agent that inhibits clot formation by preventing platelet activation and aggregation.
Anticoagulants, like Eliquis, primarily inhibit the coagulation cascade and fibrin formation. Antiplatelet and anticoagulant drugs are used in different indications, have different mechanisms of action, different times to onset, duration of effect, and are required in different dosages.
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For example, a medical provider might recommend a therapeutic dosage of an anticoagulant to patients with VTE or atrial fibrillation and an antiplatelet for those with atherosclerosis. A combination of antiplatelet and anticoagulant drugs might be indicated under specific conditions and should be managed and monitored by a medical provider.
Conclusion
Eliquis is an anticoagulant drug that acts as a direct, selective factor Xa inhibitor. According to clinical trials, Eliquis is well tolerated for the prevention of stroke in patients with atrial fibrillation and the prevention of VTE following knee or hip replacement. Eliquis appears to be superior to warfarin in effectiveness with lower risk for significant bleeding.
Fish oil is an antiplatelet agent that can also reduce the risk of blood clotting. Adequate omega-3 intake may benefit healthy populations by lowering the risk of cardiovascular disease or be used as a holistic treatment for unhealthy populations with provider supervision. However, fish oil should not be taken instead of Eliquis or any other prescribed medication unless advised by a physician.
Do not suddenly stop using Eliquis, or any other prescription medication, unless your provider specifically advised you to do so. If you want to stop Eliquis or switch to another blood thinner option, ask your provider how to do so safely.
