Beckert Benjamin W, Concannon Matthew J, Henry Steven L, Smith Daniel S, Puckett Charles L
Columbia, Mo. From the Division of Plastic Surgery and Department of Pathology and Anatomical Sciences, University of Missouri.
Plast Reconstr Surg. 2007 Dec;120(7):2044-2050. doi: 10.1097/01.prs.0000295972.18570.0b.
Herbal medicines are used by a considerable number of surgical patients. An increased risk of bleeding, substantiated by anecdotal reports, has been attributed to the use of certain herbs, and numerous in vitro experiments have identified some herbal extracts as platelet inhibitors. The purpose of this investigation was to determine whether standard commercial preparations of commonly used herbal medicines have an effect on platelet function in vivo and, by extension, to provide clinical scientific evidence of the safety of their use in the perioperative period.
Five commercially available herbal agents were investigated, including Ginkgo biloba, garlic, Asian ginseng, St. John's wort, and saw palmetto. In a blinded fashion, one of the agents was administered to 10 adult volunteers at the manufacturer's recommended dose for 2 weeks. At the end of the 2-week period, in vivo platelet function was quantified using the PFA-100 assay. After a 2-week "washout" period, the protocol was repeated using a different agent. This 4-week cycle was repeated for each of the five herbal agents, as well as the control agent aspirin.
In vivo platelet function was not affected by the administration of any herbal agent and was markedly inhibited with the administration of aspirin.
The herbal medicines investigated in this study do not affect platelet function in vivo. Neither this experiment nor a review of the literature supports the concern of perioperative bleeding in users of these herbal medicines.
相当数量的外科手术患者使用草药。一些轶事报道证实，使用某些草药会增加出血风险，并且大量体外实验已将某些草药提取物鉴定为血小板抑制剂。本研究的目的是确定常用草药的标准商业制剂在体内是否对血小板功能有影响，并进而提供其在围手术期使用安全性的临床科学证据。
对五种市售草药制剂进行了研究，包括银杏、大蒜、亚洲人参、圣约翰草和锯叶棕。以盲法将其中一种制剂按照制造商推荐剂量给予10名成年志愿者，持续2周。在2周结束时，使用PFA-100检测法对体内血小板功能进行量化。经过2周的“洗脱”期后，换用另一种制剂重复该方案。对五种草药制剂以及对照制剂阿司匹林，均重复这个4周的周期。
体内血小板功能未受任何草药制剂给药的影响，但阿司匹林给药后则受到显著抑制。
本研究中所调查的草药在体内不影响血小板功能。无论是本实验还是文献综述，均不支持这些草药使用者围手术期出血的担忧。
