Herbal Supplements Can Increase Bleeding Risk at Surgery


Sixty percent of Americans choose homeopathic drugs, food supplements, or herbal products as an alternative to traditional medications to enhance their health. These products are pharmacologically active and naturally occurring plant extracts. Because their source is “natural” and they are sold without a prescription, they have increased in popularity for those seeking a wholesome life style. Despite their natural source, supplements can contribute to prolonged and excessive bleeding at surgery. Here is a list of some of the commonly used complementary/alternative medical products that can be harmful when combined with surgery. The following should be tapered and then discontinued two to three weeks before surgery.

BAICAL SKULLCAP (Chinese Skullcap)- This herb has been used by the Chinese for irritability and dysentery. It interferes with coagulation and can cause bleeding.

BROMELIN. This extract of pineapple is used to treat arthritis. It interferes with platelet function and can cause bleeding.

CHINESE AGRIMONY- This remedy is used for cough and colds, pain relief, and infections. It markedly increases the risk of bleeding.

CHINESE PEONY- Used for gastric upset, this flowering plant interferes with coagulation.

FEVERFEW- Used to reduce fever, treat arthritis and prevent migraines, feverfew can result in withdrawal symptoms as it is discontinued.

FRITILLARIA- This bulb is cooked and eaten to treat hypertension, lung problems and opium toxicity. DAN S HEN- This Chinese product is used for stroke, angina, arthritis, insomnia, and menstrual disorders. It has a powerful antiplatelet effect that leads to bleeding.

DEVIL’S CLAW- Used for centuries in South America for pain, fever, and digestion, Devil’s Claw interferes with normal coagulation.

GARLIC- Garlic has been used as a medicine for centuries. It has been advocated for high blood pressure, fungal infections, heart attack and cancer. There is good evidence of garlic in high doses resulting in bleeding, nausea and vomiting as well as low blood sugar.

GINGER- Ginger is for gastric, distress, migraines and headaches. It is known to interfere with platelet function.

GINSENG- Conditions treated with ginger include colic, infections, aging, and stress. It can increase bleeding, and have side effects of nausea, headaches, and blood pressure changes.

GINKO- Used to treat Alzheimer’s and other memory disorders, ginkgo has been associated with excess perioperative bleeding.

LICORICE- Used for peptic ulcers, cancer, and adrenal insufficiency, licorice can increase bleeding, result in hypertension and lower potassium levels.

CAPSAICIN (red chili pepper)- Capsaicin has been recommended for pain relief, itching and psoriasis. It interferes with platelet function.

SAW PALMETTO- this is a treatment for an enlarged prostate and urinary tract infections. It interferes with normal coagulation.

OIL of WINTERGREEN- Prescribed for inflammation, joint pain, and hypertension, this food flavoring agent has been associated with prolonged surgical bleeding. GEUM JAPONICUM- This diuretic can cause prolongation of clotting time.

JAPANESE HONEYSUCKLE- Homeopathic remedy for fever, ore throat, headache, and infection, Japanese honeysuckle interferes with platelet function.

DAN SHEN- Conditions treated with dan shen include atherosclerosis, insomnia, menstrual disorders, HIV, stroke, angina, and prostatitis. It blocks platelet function and can lead to prolonged bleeding.

VITAMIN E- Popular as an anti-cancer anti-oxidant there is increase in bleeding risk with high does.

FISH OIL- Fish oils are popular for their anti-cardiovascular disease benefits. It is also used to treat dry eyes. Prolonged bleeding times occur and is dependent on the dose.

ARNICA MONTANA- Used in Europe to treat arthritis and muscle aches, it has been popular to reduce postoperative bleeding and swelling. It is associated with bleeding as it interferes with platelets.

CHONDROITAN and GLUCOSAMINE – These two are often taken together to enhance cartilage repair. They increase bleeding potential. Supplements and old-fashioned remedies are not generally thought of as medicines and thus many do not mention them to their doctors. These substances may have been in use for centuries, but they can have harmful effects at the time of surgery. They are classified as a food rather than a drug, so they escape FDA regulation. This can make them variable in quality or dosage.

Make sure your surgeon knows what non-prescription items you are taking so as to avoid any unsafe interactions at the time of your procedure.

Category: Doctor-Patient Relationship, Nutrition, Personal Fitness

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