Stroke recovery: jury is still out on benefits of fish oil

  • Alvarez Campano CG & al.
  • Cochrane Database Syst Rev
  • 26 Jun 2019

  • International Clinical Digest
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Takeaway

  • Cochrane review finds high uncertainty about benefits of fish oil on functional outcomes after stroke or transient ischemic attack (TIA).

Why this matters

  • Increasing burden of stroke.

Key results

  • Short follow-up (≤3 months):
    • Poor functional outcome on Glasgow Outcome Scale Extended (risk ratio [RR], 0.78; 95% CI, 0.36-1.68).
    • Mood on 30-item General Health Questionnaire favored control (mean difference [MD], 1.41; 95% CI, 0.07-2.75).
    • No significant effect:
      • Vascular-related death.
      • Recurrent events.
      • Incidence of other type of stroke.
      • QoL.
    • Adverse events:
      • Extracranial hemorrhage (RR, 0.25; 95% CI, 0.04-1.73).
      • Bleeding complications (RR, 0.32; 95% CI, 0.01-7.35).
  • Longer follow-up (>3 months):
    • Functional outcome:
      • Barthel Index (MD, 7.09; 95% CI, –5.16 to 19.34).
      • Rivermead Mobility Index (MD, 1.30; 95% CI, –1.31 to 3.91).
      • Vascular-related death (RR, 1.02; 95% CI, 0.78-1.35).
      • Fatal recurrent events (RR, 0.69; 95% CI, 0.31-1.55).
    • No effect on mood.
    • Other types of stroke, QoL not reported.
    • Adverse events (RR, 0.94; 95% CI, 0.56-1.58).

Study design

  • 29 randomized controlled trials, marine-derived omega-3 polyunsaturated fatty acids (fish oil, fish intake, or supplements) vs placebo/open control after stroke, TIA, both.
  • Outcomes for 9 trials, 3339 participants.
  • Main outcome: functional outcome.
  • Funding: University of Aberdeen; others.

Limitations

  • Limited high-quality evidence.
  • Single trial in acute setting.

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