Dietary supplements and bleeding. Issue 6 (2nd November 2022)

• Record Type: Journal Article
• Authors: Hatfield, Jess; Saad, Saadeddine; Housewright, Chad
• Is Part Of: Proceedings. Volume 35:Issue 6(2022)
• Page Start: 802
• Page End: 807
• Publication Date: 2022-11-02
• Subjects: Anticoagulants -- bleeding -- dietary supplements -- herbal supplements -- surgical bleeding; Medicine -- Periodicals; Medicine; Medicine -- Periodicals; Periodicals; Electronic journals; 616.005
• DOI: 10.1080/08998280.2022.2121575
• Languages: English
• ISSNs: 0899-8280

Abstract

Abstract: An estimated one-third of US adults use herbal supplements, often without reporting that use to their physicians. These supplements can potentially alter bleeding and coagulation during surgery and when used concomitantly with anticoagulants. Our objective was to provide a comprehensive review of the evidence of bleeding risks of the most popular herbal and dietary supplements. A PubMed search and review of the literature was performed. We found that garlic and hawthorn supplementation is strongly associated with surgical bleeding independent of anticoagulants. Cordyceps sinensis, echinacea, and aloe vera are loosely associated with surgical bleeding independent of anticoagulants. In patients on anticoagulants, ginkgo biloba, chondroitin-glucosamine, melatonin, turmeric, bilberry, chamomile, fenugreek, milk thistle, and peppermint are associated with bleeding risk. No evidence was found for bleeding with these supplements independent of anticoagulants. Fish oil, ginseng, and saw palmetto are not associated with bleeding. Evidence for overall bleeding risk associated with St. John's wort, ginger, ginkgo biloba, or cranberry supplementation is conflicting. In conclusion, physicians must be aware of the potential anticoagulant effects of these supplements. It is imperative to report dietary and herbal supplement usage to physicians and is best to discontinue nonessential supplement use 2 weeks prior to surgery.