Hatfield Jess, Saad Saadeddine, Housewright Chad
Texas A&M Health Science Center College of Medicine, Temple, Texas.
Department of Dermatology, Baylor Scott and White Medical Center - Temple, Temple, Texas.
Proc (Bayl Univ Med Cent). 2022 Sep 15;35(6):802-807. doi: 10.1080/08998280.2022.2121575. eCollection 2022.
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.
据估计，三分之一的美国成年人使用草药补充剂，而且往往不会向医生报告这种使用情况。这些补充剂在手术期间以及与抗凝剂同时使用时，可能会改变出血和凝血情况。我们的目的是全面综述最常用的草药和膳食补充剂出血风险的证据。我们在PubMed上进行了文献检索和综述。我们发现，补充大蒜和山楂与手术出血密切相关，与是否使用抗凝剂无关。冬虫夏草、紫锥菊和芦荟与手术出血存在一定关联，与是否使用抗凝剂无关。对于正在服用抗凝剂的患者，银杏、软骨素-葡萄糖胺、褪黑素、姜黄、越橘、洋甘菊、葫芦巴、水飞蓟和薄荷与出血风险有关。未发现这些补充剂在不使用抗凝剂时会导致出血的证据。鱼油、人参和锯棕榈与出血无关。关于圣约翰草、生姜、银杏或蔓越莓补充剂总体出血风险的证据存在矛盾。总之，医生必须了解这些补充剂潜在的抗凝作用。务必向医生报告膳食和草药补充剂的使用情况，并且最好在手术前2周停止使用非必要的补充剂。
