20 Fish Oil Benefits And Side Effects

There are so many people who take fish oil every day but do you know what is fish oil benefits and side effects?

Fish oil is a common animal source of omega-3 because it contains essential fatty acids DHA and EPA that are beneficial to the human body, and compared to plant-derived omega-3, it is easy to be converted by the human body (such as ALA in flaxseed oil is only about 5-15% can be converted to DHA+EPA), so it becomes the first choice for supplementing omega-3 (other similar products still have cod liver oil or krill oil).

What are the benefits of ingesting fish oil? Are there any side effects? See the article for details.

Table of Contents

What is fish oil (Omega-3)?

Omega-3 fatty acids are a kind of nutrients, mainly composed of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Since the human body cannot synthesize effectively, dietary intake is the main source, such as fish, Seafood, flax seeds, perilla oil, etc.

These fatty acids are not only an important source of energy for the human body but also a key structural component that maintains the integrity and fluidity of cell membranes.

In addition, they can also serve as precursors for biologically active mediators, such as eicosanoids (prostaglandins, leukotrienes, and thromboxanes) and steroid hormones, and regulate gene expression and cell signaling pathways (apoptosis, inflammation, and cells) Mediated immune response.

Because omega-3 has an excellent anti-inflammatory effect and does not have many side effects of anti-inflammatory drugs, it is called the most effective natural anti-inflammatory drug.

Insufficient or unbalanced intake is considered to be related to many health problems, such as heart disease, cancer, schizophrenia, allergies, depression, Alzheimer’s disease, etc.

What are the benefits recommended for fish oil (omega-3)?

1. Fish oil reduces the risk of cardiovascular disease

Cardiovascular diseases are considered to be the most expensive diseases, even surpassing Alzheimer’s disease and diabetes. The annual indirect cost is 237 billion US dollars, which is expected to increase to 368 billion US dollars by 2035.

Risk factors related to this disease include smoking, alcoholism, low physical activity levels, and insufficient intake of vegetables and fruits. On the other hand, unchangeable factors such as family history, age, and gender have different meanings.

Family history, especially when first-degree relatives were diagnosed with cardiovascular disease or died of cardiovascular disease before age 55 (male) or age 65 (female), was considered an independent risk factor.

A literature meta-analysis (Meta-Analysis, including 13 randomized controlled trials with a total of 127,477 participants) pointed out that supplementation with marine omega-3 (daily dose between 376 mg and 4000 mg, average follow-up time of 5 years) can significantly reduce myocardium Risk of infarction, total coronary heart disease, and total cardiovascular disease.

In addition, the associated risk reduction appears to be linearly related to the dose of omega-3.

*Conclusion: Supplementation of marine omega-3 can positively help reduce the risk of cardiovascular disease, especially for patients who use larger doses, but the relevant results still need to be supported by more large-scale trials

2. Fish oil is beneficial for psoriasis

Psoriasis is the most autoimmune multi-system inflammatory disease mainly based on skin and joints. The most common type is chronic plaque-type psoriasis, affecting more than 80% of patients. The characteristic is that the skin erythema is covered with silvery-white scales (clear and symmetrical).

The prevalence rate is 0.1% to 11.8% in different populations, with an average of 2% to 3%. The age of onset is bimodal (16 to 22 years old and 57 to 60 years old), and the incidence rate is the same for men and women.

In addition to the physiological impact of the disease, psoriasis has a wide range of emotional and psychosocial effects on patients. It can lead to stigmatization, low self-esteem, increased stress, and affect social functions and interpersonal relationships.

A meta-analysis of literature (including 3 randomized controlled trials with a total of 625 psoriasis participants) pointed out that fish oil supplementation did not significantly reduce the severity of psoriasis (as measured by Psoriasis Area and Severity Index score).

*Conclusion: As of now, there is no clear evidence to support the use of fish oil supplements for the treatment of psoriasis/psoriasis, and further studies are needed to further verify.

3. Fish oil benefits allergies

Allergy is defined as the result of an immune response to specific types of antigens, mainly protein antigens (called allergens), affecting approximately 30% of the world’s population.

It is characterized by the production of specific IgE, which binds to mast cells and triggers a series of molecular and cellular events, which in turn affect the respiratory tract (rhinitis and asthma), skin (dermatitis, urticaria) and various systems (allergic reactions) Various allergens, including pollen, mold spores, animal dander, insect bites, food, and medicine.

A systematic literature review and meta-analysis (including 5 randomized controlled trials) indicated that supplementation of omega-3 fatty acids during childhood did not reduce the incidence of allergic diseases (including any specific reactions, asthma/wheezing, eczema), Specific reaction rhinitis, food allergies, sensitization).

*Conclusion: Due to the limited number of studies and the heterogeneity between the studies, supplementation of omega-3 fatty acids in childhood has not significantly helped prevent allergy-related diseases, and needs to be further verified by more large-scale studies in the future.

4. Fish oil improves insulin sensitivity

Insulin has a variety of physiological functions, of which hypoglycemia is the main function. In addition, insulin can stimulate the synthesis of fatty acids and glycogen, promote mitochondrial function, improve microcirculation, and induce cell proliferation.

When insulin-sensitive tissues lose their response to insulin, insulin resistance occurs and is the main cause of type 2 diabetes, which often occurs years before the onset of type 2 diabetes.

In the insulin sensitivity test, insulin resistance has the following characteristics: fasting hyperinsulinemia, hyperglycemia, elevated glycated hemoglobin, postprandial hyperglycemia, hyperlipidemia, impaired glucose tolerance, impaired insulin tolerance, Glucose infusion rate slows down, liver sugar production increases, insulin secretion decreases in the first stage, hypoadiponectinemia, and plasma inflammation indicators increase.

A systematic literature review and meta-analysis (including 17 randomized controlled trials with a total of 672 participants) indicated that overall, fish oil supplementation (daily doses ranged from 1 to 4 grams, compared to placebo) Intervention time varies from 4 weeks to 24 weeks has no effect on insulin sensitivity.

However, subgroup analysis shows that for subjects with at least one metabolic syndrome, supplementation with fish oil may be beneficial to insulin sensitivity, and short-term intervention (within 12 weeks) is more effective for a longer period.

*Conclusion: For those with metabolic syndrome, short-term supplementation with fish oil may have a positive effect on improving insulin sensitivity, but limited by the small sample size and the quality of the methodologies in the trial, more research is needed to corroborate.

5. Fish oil is beneficial for depression

Depression (Major depressive disorder) is characterized by persistent depression, accompanied by changes in behavior, cognition, sleep, and appetite, impaired social and professional functions, and increased risk of self-harm or suicide.

Although short-term treatment of acute episodes of depression is usually effective, many patients relapse after short-term improvement or remission.

Within 10 years of the onset of depression, the recurrence rate exceeds 85%. If the initial effective treatment is not continued, the average relapse rate within 6 months of obvious clinical remission is about 50% or more.

A meta-analysis of literature (including 26 randomized controlled trials, a total of 2160 adults diagnosed with clinical depression) pointed out that omega-3 polyunsaturated fatty acids have a positive therapeutic effect on depression symptoms.

In addition, subgroup analysis found that the relevant improvement effect is most significant especially in the following conditions, EPA daily dose ≤1 g, EPA-pure (100% EPA), and EPA-major formula (≥60% EPA).

The DHA-pure and DHA-major formulas did not significantly help

*Conclusion: The use of fish oil/omega-3 (under certain EPA dosage and ratio conditions) may have a positive effect on the improvement of depression symptoms, but due to the potential heterogeneity, more research is still needed to further verify

6. Fish oil improves Alzheimer’s disease

Alzheimer’s disease is by far one of the most common causes of dementia (accounting for 80% of all dementia diagnoses) and is characterized by the gradual decline of several cognitive functions (including memory, language, executive and Visual-spatial function, personality and behavior), which leads to the loss of basic mobility.

Currently available treatments include cholinesterase inhibitors and memantine, these drugs have been proven to improve the quality of life of patients and caregivers, however, the drugs will not change the course of the disease or the rate of decline.

A systematic review (including 7 randomized, double-blind placebo-controlled trials related to Alzheimer’s disease) pointed out that compared with placebo, fish oil supplementation did not significantly improve the symptoms, but improved Partly only seen in a few cognitive assessment scales and mild or early patients.

*Conclusion: As of now, there is no consistent evidence to support the effectiveness of fish oil supplements in improving Alzheimer’s disease in the short and medium-term.

7. Fish oil is beneficial for dry eye

Dry Eye Disease, also known as keratoconjunctivitis sicca, is a multifactorial disease of the ocular surface, characterized by the loss of steady-state of the tear film, accompanied by tear film instability and high osmotic pressure, ocular surface inflammation and Eye symptoms such as abnormal nerve sensation.

Known risk factors include aging, females, hormonal changes (such as after menopause), eyelid diseases, refractive surgery, autoimmune diseases, and smoking.

Environmental risk factors include wearing contact lenses, low humidity (such as an air-conditioned environment), exposure to sunlight, dust and air pollution, drugs, etc.

A meta-analysis (Meta-Analysis, including 17 randomized clinical trials with a total of 3363 dry eye patients) pointed out that omega-3 fatty acid supplements (fish oil) can help reduce dry eye symptoms and corneal fluorescence compared to placebo The value of light staining was checked, and the tear film break-up time (BUT) and Schirmer tear secretion test values ​​were increased.

*Conclusion: omega-3 supplements (fish oil) may have a positive effect on the improvement of dry eye, but due to the heterogeneity of the included studies, more rigorous research is still needed to corroborate them.

8. Fish oil benefits male infertility

Infertility is a psychological, economic, and medical problem, it can cause trauma and stress, especially in a social structure such as ours that emphasizes lineage succession.

It is estimated that nearly 72.4 million couples worldwide have fertility problems, of which 40% to 50% of infertility are “male factor” infertility. The most common factors are low sperm concentration (hypothermia), poor sperm motility, and abnormal sperm morphology (teratozoospermia).

A systematic literature review and meta-analysis (including 3 randomized, double-blind, placebo-controlled trials, a total of 275 male infertility patients) pointed out that oral omega-3 (fish oil) can significantly improve sperm motility/ Sperm motility and semen DHA concentration.

The underlying mechanism may be related to omega-3’s ability to maintain the structural integrity of sperm cell membrane phospholipids and reduce oxidative stress.

*Conclusion: For male infertility patients, omega-3 (fish oil) can help improve sperm motility and positively help infertility, but limited by the small sample size and heterogeneity, more research is still needed to corroborate.

9. Fish oil benefits non-alcoholic fatty liver

Nonalcoholic fatty liver disease usually refers to unexplained secondary liver fat accumulation (when liver cells contain more than 5% fat), and excludes the following conditions: such as congenital metabolic abnormalities, Wilson disease, excessive Alcohol, hepatitis, toxins, iron toxicity or hepatotoxic drugs).

Non-alcoholic fatty liver disease (NAFLD) can generally be divided into two subtypes, namely: non-alcoholic fatty liver disease (NAFL, simple steatosis) or non-alcoholic steatohepatitis (NASH). Compared with NAFL, NASH has a much higher risk of developing cirrhosis.

A literature review and meta-analyses (including 18 studies) pointed out that for non-alcoholic fatty liver (NAFLD) patients, supplementation with Omega-3 fatty acids can significantly improve 6 of 13 metabolic risk factors (including Body Mass Index, HOMA-IR, total cholesterol, LDL-C, HDL-C, Triglyceride), 2 of 3 liver enzymes (ALT and GGT) and steatosis score.

In addition, for nonalcoholic steatohepatitis (NASH), supplementation of Omega-3 fatty acids has not been found to be helpful for liver histological parameters (including fibrosis, hepatocyte balloon-like degeneration, steatosis, lobular inflammation, and non-alcoholic degeneration). Alcoholic fatty liver activity).

*Conclusion: Supplementation of Omega-3 fatty acids (sources include fish oil and algae oil) may have a positive effect on milder non-alcoholic fatty liver.

10. Fish oil is beneficial to fetal brain development

The intake of omega-3 (EPA + DHA) during pregnancy is very important for fetal development, especially in the third trimester/third trimester (28 to 40 weeks of pregnancy), DHA will accumulate in large amounts in the brain and retina, which has a decisive effect on normal development force.

In a small double-blind controlled study, it was found that pregnant women who had taken DHA had higher scores in problem-solving tests (tested at 9 months of age, compared to those who did not ingest).

Another trial also found that during pregnancy (from the beginning of 20 weeks to before childbirth) intake of omega-3 (2.2 g DHA + 1.1 g EPA per day), children’s hand-eye coordination test scores at 2 years of age is significantly better.

11. Fish oil reduces the premature birth rate

The preterm delivery event is mainly defined as delivery before the complete pregnancy cycle (37 weeks or 259 days). It is estimated that 10% to 11% of the approximately 15 million newborns worldwide each year are premature.

In general, there are many factors that cause births, which may be related to socioeconomic status, prolificity, previous abortion experience, mental illness, prenatal bleeding, vaginal infections, psychological pressure, smoking, alcoholism, and illegal drug use.

A meta-analysis of 21 randomized controlled trials (a total of 10,802 pregnant women) pointed out that fish oil supplementation during pregnancy can increase the gestational age of newborns and reduce early preterm birth (22%)  Early chance of premature delivery (10%), but also better birth weight, birth length, and head to head ratio (but cannot reduce intrauterine growth restriction and stillbirth events).

*Conclusion: Fish oil supplementation during pregnancy can help reduce preterm births and have a better newborn size.

Where to buy fish oil capsules recommended by most people?

In recent years, food safety problems in various countries have exploded, and it is not healthy but black-hearted products that everyone spends on. Therefore, European and American products with relatively strict quality control have become popular products.

And iHerb.com is a large-scale medical cosmetics e-commerce company in the United States. It has a high satisfaction rate of 97% in the evaluation of Google customers. It provides global home delivery so that you can buy it without risking buying fakes through purchasing high-quality health products.

Fish Oil

==>Click here to buy and enjoy a 5% Discount for all the products and get 10% Credit Rewards for you to buy anything next time<==

12. Fish oil reduces the risk of hip fracture

As the population ages, hip fractures caused by falls are the main cause of the decline in quality of life, mainly related to decreased bone density, muscle atrophy, and sensory nerve degradation.

The mortality of hip fracture surgery in the first and second years is as high as 22% and 47%, and nearly 50% of patients cannot return to their pre-fracture state.

A meta-analysis of literature (including 9 studies with nearly 300,000 participants) pointed out that higher fish intake and Omega-3 dietary intake have a protective effect on bone quality and can reduce the risk of hip fracture.

The underlying mechanism may be related to the increase in intestinal calcium absorption, inhibition of bone resorption, reduction of urinary calcium excretion, and regulation of inflammation in Omega-3 fatty acids.

*Conclusion: Taking more Omega-3 from fish or other seafood can reduce the incidence of hip fractures.

13. Fish oil benefits chronic kidney disease

Chronic Kidney Disease (CKD), also known as chronic renal failure, is a disease that gradually loses kidney function. It is estimated that about 10% to 16% of the adult population worldwide is affected by this disease.

As the disease progresses, chronic kidney disease may produce serious complications, such as cardiovascular disease, hyperlipidemia, anemia, and metabolic bone disease. If it is the end stage of renal failure, kidney dialysis, or even kidney transplantation is often required.

A literature meta-analysis (including 9 randomized controlled trials with 444 chronic kidney disease participants) pointed out that supplementation of omega-3 (fish oil) can help reduce the risk of proteinuria and end-stage renal disease (ESRD) (But creatinine clearance and glomerular filtration rate have no effect).

*Conclusion: Supplementation of Omega-3 fatty acids can delay the progression of chronic nephropathy and reduce the incidence of End-Stage Renal Disease.

14. Fish oil is beneficial to primary dysmenorrhea

Menstrual pain is mainly caused by menstrual uterine cramps. The primary dysmenorrhea without pelvic cavity disease is the most common. The prevalence rate is between 45% and 95%, which affects life greatly.

A double-blind cross-over study pointed out that (for a period of 6 months, the subject was 95 women with primary dysmenorrhea), oral omega-3 fatty acids can not only help reduce the pain of menstrual pain but also reduce the dosage of analgesics.

The underlying mechanism is related to the immune regulation of omega-3 unsaturated fatty acids (fish oil), the suppression of inflammation mediators and pain signals, and the release of beta-endorphin.

*Conclusion: Supplementing omega-3 unsaturated fatty acids (fish oil) may help reduce menstrual pain symptoms and drug use, but more large-scale experiments are still needed to confirm.

15. Fish oil to prevent post-traumatic stress syndrome (PTSD)

Post-traumatic stress syndrome (PTSD) was first discovered in war (due to various lingering mental symptoms of soldiers after the war), and these situations also often occur in various natural disasters, terrorist attacks, and various violent incidents.

It is estimated that about 60.7% of men and 51.2% of women will experience PTSD after trauma or catastrophe. Symptoms usually occur within 1 month after the event. Most people will recover within 6 months, but it may also persist Longer time.

Common symptoms of post-traumatic stress syndrome include repeated horror memory, avoid talking about related topics, forget important details, alcohol dependence, and so on. Emotionally, the patient loses feelings about everything, alienates, forgets, and becomes irritable, anxious, guilty, and even sleep-disordered.

According to preliminary research by Japanese psychiatrist Yutaka MATSUOKA, omega-3 is currently the best natural ingredient for preventing post-traumatic stress syndrome.

One of the effective mechanisms of omega-3 is to stimulate the growth of BDNF (brain-derived nerve growth factor) in the hippocampus, which can promote nerve differentiation and regulate nerve conduction substances, thereby reducing the solidification of terror.

16. Fish oil reduces suicidal intentions

In modern high-pressure society, suicide has become one of the ten new causes of death. There are often several suicides in daily news headlines. Not only are they not concealed, but they also expose the suicide methods and pictures to the world, which may not only bring imitation The effect is more likely to be the driving force for suicide.

According to large-scale epidemiological observations, it is found that the intake of less fish is significantly associated with depression and suicidal behavior, and those with lower DHA concentrations in the brain may increase suicidal intentions by 5 to 6 times.

Lack of omega-3 can increase certain mental symptoms related to stress, such as suicide, adaptation, depression, violent impulse, etc.

A survey of American soldiers found that suicide and intentional suicides had lower levels of omega-3 (mainly DHA) in the blood, compared with those with higher DHA and the lowest blood concentration 62 %.

In addition, a double-blind controlled study (for patients with recurrent self-mutilation) found that 2 grams per day (EPA + DHA) for 12 consecutive weeks can reduce suicidal thoughts by 45% and depression by 30%.

17. Fish oil reduces the incidence of cancer

Statistics in the past decade have found that men suffering from colorectal cancer and prostate cancer are on the rise, while women are mainly breast cancer and colorectal cancer. What is closely related to these cancers is our daily diet. In fact, due to diet, The proportion of cancer caused by daily life and rest has been as high as 90%, and less than 10% is related to genetics and viruses.

Related studies have also found that women who are in early breast cancer can reduce the recurrence rate of breast cancer by 25% if they can consume more omega-3 (DHA+EPA) from fish.

Another 15-year observation also found that no matter whether it is pre- or breast cancer patients, if they can consume more oil-rich fish (such as tuna), it can reduce all-cause mortality by up to 34% (compared to Yu people who have not eaten fish).

Regarding male prostate cancer, although no association between the intake of fish and the incidence of prostate cancer has been found, it can reduce prostate cancer mortality by 63%.

18. Fish oil to prevent postpartum depression

Generally speaking, many pregnant women tend to experience emotional instability or extreme depression (the chance of occurrence is about 20%) due to the hormones in the body that have not been balanced within one month after the birth of the child, and the challenges of parenting.

Depending on the degree of maternal depression, a variety of symptoms will appear, including insomnia, loss of appetite, fatigue, and other symptoms. In more serious cases, there may be harm to the child or even suicide intentions.

A cross-country observation found that postpartum depression and the lack of omega-3s in pregnant women are strongly associated with less seafood intake14. The supplementation of omega-3 may have preventive and improvement effects, but some studies have not found a connection, so more research is still needed to confirm.

19. Fish oil improves acne

Acne is one of the most common skin diseases. It occurs regardless of race and age. It is estimated that about 80% of 11 to 30 years old suffer from various levels of acne, which makes the patient feel inferior, which seriously affects the Interpersonal relationships.

A recent small controlled study found that the subjects (men and women 18 to 33 years old with mild to moderate acne), whether taking omega-3 (DHA+EPA) or omega-6 (GLA), can significantly improve The number and severity of pimples (the number of inflammatory pimples decreased by 42.6%, the severity decreased by 29%, without any side effects).

20. Fish oil benefits rheumatoid arthritis symptoms

Rheumatoid arthritis is an autoimmune disease in which immune cells mistake joints as enemies, which in turn attack inflammation. Nearly two million people in the United States are affected by this disease (women are good) Hair group, the attack rate is three times that of men), resulting in joint deformation, swelling, and stiffness.

In addition to joints, rheumatoid arthritis may also invade other organs, causing inflammation of the heart, eyes, lungs, and even the mouth. If not properly treated, 20 years later, it will cause 80% of patients to lose their mobility and seriously affect their quality of life.

Because of its excellent anti-inflammatory effect, fish oil has been observed in a 7-year-old Swiss observation that women who regularly consume fish oil can reduce the incidence of rheumatoid arthritis by 52%.

In addition, dozens of clinical studies have also confirmed that taking high doses of fish oil has the effect of soothing rheumatoid arthritis, can reduce the cellular inflammation of synovial fluid, and reduce the use of non-steroidal anti-inflammatory drugs NSAID.

How to eat fish oil? What is the dosage?

The study found that fish oil combined with a fat-rich diet can increase the absorption rate several times, so it is the best time to take with a meal.

The Reference Daily Intake (RDI) of total omega-3 is generally 1100 mg for women and 1600 mg for men and will vary according to different ages and health status.

According to the European Food Safety Authority, it is safe to consume 5000 mg of omega-3 fatty acid supplements per day, but such a high intake may be unnecessary for most people and may There are potential risks.

It is recommended to eat two servings of fatty fish (8 ounces or 224 grams) per week to provide you with enough omega-3 fatty acids, otherwise, you may lack EPA and DHA.

What are the side effects of fish oil (omega-3)?

For most people in good health, it is safe to take fish oil at the appropriate dosage (3 grams or less per day).

Possible side effects or adverse reactions that have been reported include: acid reflux, flatulence, hiccups, dyspepsia, dizziness, headache, bad breath, heartburn, nausea, loose stools, weakness in hands and feet, difficulty breathing, difficulty swallowing, rash, nosebleeds, Urine is red or dark brown, chest tightness, swelling of the face, night sweats.

Safety precautions

1. It may be unsafe to consume large amounts of fish oil from certain natural food sources, such as some large-scale deep-sea fish species, especially tuna, swordfish, oilfish, the shark may be contaminated with mercury or industrial and environmental chemicals, often Eating contaminated fish can cause brain damage, mental retardation, blindness and epilepsy in children.

2. Patients with familial colorectal polyposis/adenomatous polyposis (Familial adenomatous polyposis) should be used with caution. There have been suspected cases that long-term use will increase the risk of cancer.

3. Fish oil may increase the risk of arrhythmia in patients with implanted defibrillators. For safety reasons, patients should avoid using fish oil supplements.

4. Those who have been allergic to fish, shrimp and any seafood protein, please avoid or use fish oil supplements with caution (although fish oil has been refined, it is reasonable to say that it does not contain protein, but there is no guarantee that it will not cause allergies).

5. People with abnormal immune function should not take too much, because it has been found in animal experiments that supplementation with high doses of fish oil may cause immunosuppressive symptoms (the converted human dose is about 2.2g to 22g).

6. Fish oil has the effect of lowering blood pressure, so patients with hypotension or taking antihypertensive drugs should use it with caution. The names of the related drugs are captopril, enalapril, losartan, valsartan, diltiazem, Amlodipine, hydrochlorothiazide, furan aniline.

7. People with diabetes should use it with caution, as high doses of fish oil may raise blood sugar levels, which may make blood sugar control more difficult.

8. Use cirrhosis or chronic liver disease with caution, because the patient’s coagulation function may be impaired, and taking fish oil may increase the risk of bleeding.

9. Do not use it in combination with contraceptives, which may affect the effectiveness of fish oil in reducing triglycerides. The relevant drug ingredients are Ethinyl estradiol, levonorgestrel, norethindrone.

10. Do not use it in combination with the diet pills Orlistat, which may affect the absorption efficiency of fish oil.

11. Fish oil has a blood-thinning effect, so please avoid using it in patients with coagulopathy (such as hemophilia) or 3 weeks before surgery.

12. Do not use in combination with anticoagulant or antiplatelet drugs, which may increase the risk of bruising or bleeding. The names of the related drugs are naproxen, dalteparin, diclofenac, ibuprofen, enoxaparin, heparin, warfarin, Aspirin, clopidogrel.