Journal List > J Rhinol > v.22(2) > 1044345

Choi and Ye: Dietary Supplements and Postoperative Bleeding

Abstract

There is a wide variety of dietary supplements on the market that are taken by patients of all walks of life. Unfortunately their use is self-prescribed and patients rarely view them as medication reveal their use to hospital staff. Garlic has been reported to inhibit platelet aggregation and may interact with anticoagulants and antiplatelet agents. Other alternative supplements have also been associated with potential increased bleeding, including ginkgo biloba, ginger, ginseng, and omega-3 fatty acid. It is essential for surgeons to be apprised of all substances ingested by patients, so they can identify potential adverse effects and drug interactions.

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Fig. 1.
Number of natural products taken per patient (adapted from reference #1).
jr-22-63f1.tif
Fig. 2.
The arachidonic acid cascade.
jr-22-63f2.tif
Table 1.
Pharmacological effects and perioperative cautions of dietary supplements and recommendations for discontinuation of use before surgery
Dietary supplements Common uses (marketing) Pharmacological effects Surgical caution Preoperative discontinuation
Garlic Anti-inflammatory Inhibition of platelet aggregation Perioperative At least 7 days
  Allium sativum Antihypertensive (dose-dependent) bleeding before surgery
  Lipid-lowering Increased fibrinolysis    
  Antithrombotic Lowers serum lipid and cholesterol levels    
Ginko Imporve cognitive deficits Inhibition of platelet activating Perioperative At least 36 hours
  Ginko biloba Circulatory stimulant factor bleeding before surgery
  Used to treat Inhibition of platelet aggregation    
  Alzheimer's disease, peripheral vascular disease, tinnitus Decreased plasma viscosity, erythrocyte aggregation Postoperative sedation  
  Antioxidant Modulates neurotransmitter activity    
Ginseng Cancer prevention Inhibition of platelet aggregation Perioperative At least 7 days
  Panax ginseng Blood glucose-lowering Similar mechanism to steroid bleeding before surgery
  Panax Protect the body against hormones Hypertension  
   quinquefolius stress and restore homeostasis   Hypoglycemia  
Ginger Anti-inflammatory Inhibition of platelet aggregation Perioperative At least 14 days
  Zingiber officinale Antiemetic Direct stimulation of the gastrointestinal tract, or serotonin antagonism in the gut or central nervous system bleeding before surgery
Omega-3 fatty acid Antithrombotic Inhibition of platelet aggregation Perioperative At least 14 days
  Fish oil Cardioprotective Inhibition of platelet activating bleeding before surgery
  Antihypertensive factor    
  Lipid-lowering Decreased plasma viscosity Increased erythrocyte membrane fluidity    
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