Wang Chong-Zhi, Moss Jonathan, Yuan Chun-Su
Department of Anesthesia & Critical Care, University of Chicago, Chicago, Illinois 60637.
Medicines (Basel). 2015 Sep;2(3):157-185. doi: 10.3390/medicines2030157. Epub 2015 Jul 27.
Patients who undergo surgery appear to use dietary supplements significantly more frequently than the general population. Because they contain pharmacologically active compounds, dietary supplements may affect coagulation and platelet function during the perioperative period through direct effects, pharmacodynamic interactions, and pharmacokinetic interactions. However, in this regard, limited studies have been conducted that address the pharmacological interactions of dietary supplements. To avoid possible bleeding risks during surgery, information of potential complications of dietary supplements during perioperative management is important for physicians.
Through a systematic database search of all available years, articles were identified in this review if they included dietary supplements and coagulation/platelet function, while special attention was paid to studies published after 1990.
Safety concerns are reported in commercially available dietary supplements. Effects of the most commonly used natural products on blood coagulation and platelet function are systematically reviewed, including 11 herbal medicines (echinacea, ephedra, garlic, ginger, ginkgo, ginseng, green tea, kava, saw palmetto, St John's wort, and valerian) and 4 other dietary supplements (coenzyme Q, glucosamine and chondroitin sulfate, fish oil, and vitamins). Bleeding risks of garlic, ginkgo, ginseng, green tea, saw palmetto, St John's wort, and fish oil are reported. Cardiovascular instability was observed with ephedra, ginseng, and kava. Pharmacodynamic and pharmacokinetic interactions between dietary supplements and drugs used in the perioperative period are discussed.
To prevent potential problems associated with the use of dietary supplements, physicians should be familiar with the perioperative effects of commonly used dietary supplements. Since the effects of dietary supplements on coagulation and platelet function are difficult to predict, it is prudent to advise their discontinuation before surgery.
接受手术的患者使用膳食补充剂的频率似乎明显高于普通人群。由于膳食补充剂含有药理活性化合物，它们可能在围手术期通过直接作用、药效学相互作用和药代动力学相互作用影响凝血和血小板功能。然而，在这方面，针对膳食补充剂药理相互作用的研究有限。为避免手术期间可能出现的出血风险，围手术期管理中膳食补充剂潜在并发症的信息对医生来说很重要。
通过对所有可用年份进行系统的数据库检索，若文章包含膳食补充剂和凝血/血小板功能，则纳入本综述，同时特别关注1990年后发表的研究。
市售膳食补充剂存在安全问题。系统综述了最常用天然产品对血液凝固和血小板功能的影响，包括11种草药（紫锥菊、麻黄、大蒜、生姜、银杏、人参、绿茶、卡瓦胡椒、锯叶棕、圣约翰草和缬草）和4种其他膳食补充剂（辅酶Q、氨基葡萄糖和硫酸软骨素、鱼油和维生素）。报告了大蒜、银杏、人参、绿茶、锯叶棕、圣约翰草和鱼油的出血风险。观察到麻黄、人参和卡瓦胡椒会导致心血管不稳定。讨论了膳食补充剂与围手术期使用药物之间的药效学和药代动力学相互作用。
为预防与使用膳食补充剂相关的潜在问题，医生应熟悉常用膳食补充剂的围手术期影响。由于膳食补充剂对凝血和血小板功能的影响难以预测，术前建议停用它们是谨慎的做法。
