Info

There Is a theoretical risk of anticoagulant activity, but It has not been Investigated In clinical trials (Chavez 1997). There are no reports of excessive bleeding

Likely to be safe

Devil's claw

Harpagophytum procumbens

Case reports suggest possible anticoagulant activity

Suspend use of concentrated extracts 1 week prior to surgery

Evening primrose oil (EPO)

Omega-6 essential fatty acids or n-6 fatty acids

Gamma llnolenlc acid In EPO affects PG synthesis leading to Inhibition of platelet aggregation -clinical significance unknown

Suspend use of high-dose concentrated products 1 week prior to surgery; however, safety Is difficult to assess

Feverfew

Tanacetum parthenium

Inhibition of platelet aggregation has been observed In several In vitro studies (Groenewegen & Heptlnstall 1990, Maries etal 1992, Voyno-Yasenetskaya etal 1988); however, a small human study found no effects on platelet aggregation (Biggs etal 1982)

Likely to be safe; however, safety Is difficult to assess

Fish oils

Omega-3 essential fatty acids or n-3 fatty acids

High doses of dietary omega-3 essential fatty acids modestly reduce thrombotic responses In vivo (Harker et al 1993). Bleeding times Increased at doses of 12 g/day of n-3 fatty acids (Harris etal 1990)

Usual dietary Intakes likely to be safe.

Suspend use of high-dose products 1 week prior to surgery

Garlic

Allium sativum

Inhibition of platelet aggregation Is clinically significant - two case reports of postoperative bleeding after excessive dietary Intake have been reported (Burnham 1995, German etal 1995). One clinical study found reduced haematocrlt values and plasma viscosity (Jung etal 1991)

Usual dietary Intakes likely to be safe.

Suspend use of concentrated extracts 1 week prior to surgery

Common name

Botanical name (where applicable)

Comments

Recommendation

Ginger root

Zingiber officinale

Oral doses of 4 g/day did not alter platelet aggregation or fibrinogen levels in one clinical study, whereas a high dose of 10 g/day significantly reduced platelet aggregation in another clinical study (Bordia et al 1997)

Usual dietary intakes likely to be safe.

Suspend use of high-dose (10 g/day) concentrated extracts 1 week prior to surgery

Ginkgo

Ginkgo biloba

Case reports of postoperative bleeding (Fessenden etal 2001, Hauseretal 2002). However, three placebo-controlled studies failed to detecta significant effect on platelet function or coagulation (Bal Dit et al 2003, Jiang etal 2003, Kohler2004)

Suspend use 1 week prior to surgery; however, safety is difficult to assess

Ginseng Korean

Panax ginseng

Inhibition of platelet aggregation has been identified in both in vitro and in vivo tests (Kuo et al 1990) but not human studies

Suspend use 1 week prior to surgery; however; safety is difficult to assess

Grapeseed extract

Vitis vinifera

Shown to inhibit platelet aggregation, and combining extracts of grape seed and grape skin produced a far greater antiplatelet effect in test tube and ex vivo tests (Shanmuganayagam et al 2002)

Suspend use of concentrated extracts 1 week prior to surgery; however, safety is difficult to assess

Guarana

Paullinia cupana

In vitro and in vivo research has identified antiplatelet activity (Bydlowski etal 1991)

Suspend use of concentrated extracts 1 week prior to surgery

Licorice root

Glycyrrhizae radix

Isoliquiritigenin inhibits platelet aggregation (Tawata et al 1992) and glycyrrhizin inhibits prothrombin (Francischetti et al 1997) according to in vitro tests - clinical significance unknown

Usual dietary intakes likely to be safe

Meadowsweet

Filipéndula ulmaría

In vitro and in vivo tests have identified anticoagulant activity (Liapina and Koval'chuk 1993) - clinical significance of these findings is unknown

Suspend use of concentrated extracts 1 week prior to surgery

Myrrh

Commiphora molmol

Guggul inhibited platelet aggregation in vitro and in a clinical study (Bordia & Chuttani 1979)

Suspend use of guggul preparations 1 week prior to surgery

Policosanol

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