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In particular, people taking fish oil or long-chain omega-3 fatty acid (EPA and DHA) supplements in combination with anticoagulant drugs, evidence based medicine including aspirin, copidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid) and warfarin (Coumadin), should evidence based medicine have their coagulation status monitored using a standardized prothrombin time assay (INR). One small study found that 3 g/day or 6 g/day of fish oil did not affect INR values in 10 patients on warfarin over a 4-week period 161 However, a recent case report evidence based medicine described an individual who required a reduction of her warfarin dose when she doubled her fish oil dose from 1 g/day to 2 g/day.162 Nutrient Interactions Vitamin E Outside the body, PUFA become rancid (oxidized) more easily than SFA. Fat-soluble antioxidants, such as vitamin E, play an important role in preventing the oxidation of PUFA. Inside the body, results of animal studies and limited data in humans suggest that the amount of vitamin E required to prevent lipid peroxidation increases with the amount of PUFA consumed.163
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