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(s) (n = 732). Five (0.68%, 95% CI 0.22–1.59%) procedures resulted in CSPPB. FO therapy was never interrupted. No deaths due to bleeding 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. Short summary While omega-3 fatty acids are known to affect hemostatic pathways, clinical evidence supporting an increased bleeding risk is lacking. This retrospective review reports the incidence of clinically significant post-procedure bleeding in children on intravenous fish oil monotherapy for treatment of intestinal failure –associated liver disease. Findings suggest that fish oil therapy is safe, with a bleeding risk no greater than that reported in the general population.