Risk of post-procedural bleeding in children on intravenous fish oil

Abstract

Background Intestinal failure-associated liver disease (IFALD) can be treated with parenteral fish oil (FO) monotherapy, but practitioners have raised concerns about a potential bleeding risk. This study aims to describe the incidence of clinically significant post-procedural bleeding (CSPPB) in children receiving FO monotherapy. Methods A retrospective chart review was performed on patients at our institution treated with intravenous FO for IFALD. CSPPB was defined as bleeding leading to re-operation, transfer to the intensive care unit, re-admission, or death, up to one month after any invasive procedure. Results From 244 patients reviewed, 183 underwent ≥1 invasive procedure (n=732). Five (0.68%, 95% CI 0.22–1.59%) procedures resulted in CSPPB. FO therapy was never interrupted. No deaths occurred. Conclusions Findings suggest that FO therapy is safe, with a CSPPB risk no greater than that reported in the general population. O3FA should not be held in preparation for procedures or in the event of bleeding.

Intravenous Fish Oil and Serum Fatty Acid Profiles in Pediatric Patients With Intestinal Failure–Associated Liver Disease

“…15 There are concerns that increased EPA concentrations may increase the risk for bleeding. 16,17 However, this concern remains controversial. In addition, there is a concern that elevated DHA and EPA levels will suppress LA's conversion to ARA, and this decline may have adverse consequences, since ARA is essential for growth and neurodevelopment.…”

Impact of Intravenous Lipid Emulsions Containing Fish Oil on Clinical Outcomes in Critically Ill Surgical Patients: A Literature Review

“…Concerns have also been raised regarding risk for bleeding with use of parenteral FO emulsions. This is due to concerns regarding EPA and DHA decreasing platelet aggregation and activation . Increased bleeding time has been reported; however, results from clinical trials have been inconsistent .…”

“…Increased bleeding time has been reported; however, results from clinical trials have been inconsistent . Studies have been unable to associate ω‐3 fatty acid use with bleeding …”

“…This is due to concerns regarding EPA and DHA decreasing platelet aggregation and activation. 45 Increased bleeding time has been reported; however, results from clinical trials have been inconsistent. 46 Studies have been unable to associate ω-3 fatty acid use with bleeding.…”

“…46 Studies have been unable to associate ω-3 fatty acid use with bleeding. [45][46][47] There have been case reports of fat overload syndrome with use of Smoflipid. 48,49 Although the most recent ASPEN/SCCM Adult Guidelines and ASPEN/SCCM Pediatric Guidelines do not suggest or recommend lipid emulsion rate limits, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society for Clinical Nutrition and Metabolism guidelines suggest lipids should be infused at 0.13-0.17 g/kg/h for infants and 0.08-0.13 g/kg/h for older children.…”