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Anticoagulant effects of phytotherapeutic drugs and their importance in surgical dental procedures

Efeitos anticoagulantes de drogas fitoterapicas e sua importância em procedimentos odontológicos cirúrgicos

ABSTRACT

Phytotherapeutic drugs are plant-derived products with medicinal properties. They are used for treating or preventing several diseases. However, patients who use these substances and even health professionals are unaware of their negative effects. One of the most common negative effects of phytotherapeutic drugs reported in the literature is the inhibition of natural coagulation factors in the human body. Therefore, the aim of this study was to perform a brief review of the literature concerning the anticoagulant effects of phytotherapeutic drugs and their importance in surgical dental procedures. Preventive measures, clarification and monitoring of patients taking phytotherapeutic drugs are recommended before performing surgical dental procedures, in order to prevent against complications such as hemorrhage.

Indexing terms:
Blood coagulation factors; Phytotherapeutic drugs; Surgical dental procedures

RESUMO

Fitoterápicos são produtos derivados de plantas com propriedades medicinais. Eles são utilizados para o tratamento ou a prevenção de diversas

doenças. No entanto, os pacientes que fazem uso destas substâncias, na sua grande maioria, desconhecem seus efeitos negativos. Portanto,

o objetivo deste estudo foi realizar uma breve revisão de literatura sobre os efeitos anticoagulantes de fitoterápicos e sua importância diante da realização de procedimentos odontológicos cirúrgicos. Medidas de prevenção, esclarecimento e acompanhamento de pacientes que se utilizam destes medicamentos são recomendados antes da realização destes procedimentos a fim de prevenir complicações como processos hemorrágicos.

Termos de indexação:
Fatores de coagulação sanguínea; Fitoterápicos; Procedimentos odontológicos cirúrgicos.

INTRODUCTION

Alternative substances for treating or preventing several diseases have aroused the interest of the population around the world, including natural substances and phytotherapeutic drugs11 Vaes LP, Chyka PA. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother. 2000;34(12):1478-82.

2 Wynn RL, Bergman SA. Drugs and herbal remedies that affect blood clotting. Gen Dent. 2002;50(6):484-8.

3 Varona F, Morales M. Ginkgo biloba y hemorragia cerebral. An Med Interna. 2005;22(4),199.

4 Shankland II WE. Four common herbs seen in dental practice: properties and potential adverse effects. Cranio. 2009;27(2):118-24.
-55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
.

Phytotherapeutic drugs are plant-derived products with medicinal properties. The literature contains several medical indications for their use, with significant positive results that include antimicrobial, anti-inflammatory and anti-oxidant effects66 Winslow LC, Kroll DJ. Herbs as medicines. Arch Intern Med. 1998;158:2192-9.-77 Pribitkin EA. Herbal medicine and surgery. Sem Integ Med. 2005;3(1):17-23. doi: 10.1016/j.sigm.2005.01.005
https://doi.org/10.1016/j.sigm.2005.01.0...
. Nonetheless, considering the many countries where they are produced and marketed88 Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall T, Riggins CW, et al. The complete german commission e monographs: therapeutic guide to herbal. Austin: Am Botanical Council; 1988., it could be reasonably assumed that the general population may use them without a medical or dental prescription, or even without appropriate dosing. About two-thirds of the patients who use phytotherapeutic drugs are unaware of their negative effects99 Bardia A, Nisly NL, Zimmerman MB, Gryzlak BM, Wallace RB. Use of herbs among adults based on evidence-based indications: findings from the National Health Interview Survey. Mayo Clin Proc. 2007;82(5):561-6. doi: 10.4065/82.5.561
https://doi.org/10.4065/82.5.561...
. In addition, in general, health professionals have a small knowledge about the negative effects of phytotherapeutic drugs22 Wynn RL, Bergman SA. Drugs and herbal remedies that affect blood clotting. Gen Dent. 2002;50(6):484-8.,44 Shankland II WE. Four common herbs seen in dental practice: properties and potential adverse effects. Cranio. 2009;27(2):118-24.,99 Bardia A, Nisly NL, Zimmerman MB, Gryzlak BM, Wallace RB. Use of herbs among adults based on evidence-based indications: findings from the National Health Interview Survey. Mayo Clin Proc. 2007;82(5):561-6. doi: 10.4065/82.5.561
https://doi.org/10.4065/82.5.561...
.

One of the most common negative effects of phytotherapeutic drugs reported in the literature is the inhibition of natural coagulation factors in the human body. Phytotherapeutic drugs, whether alone or combined with allopathic substances, may result in hemorrhage during and after surgical procedures77 Pribitkin EA. Herbal medicine and surgery. Sem Integ Med. 2005;3(1):17-23. doi: 10.1016/j.sigm.2005.01.005
https://doi.org/10.1016/j.sigm.2005.01.0...
,1010 Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-16. doi: 10.1001/jama.286.2.208
https://doi.org/10.1001/jama.286.2.208...
-1111 Saw JT, Bahari MB, Ang HH, Lim YH. Potential drug-herb interaction with antiplatelet/anticoagulant drugs. Complement Ther Clin Pract. 2006;12(4):236-41. doi: 10.1016/j.ctcp.2006.06.002
https://doi.org/10.1016/j.ctcp.2006.06.0...
. Consequently, the aim of this study was to carry out a brief review of the literature concerning the anticoagulant effects of phytotherapeutic drugs and their importance in surgical dental procedures.

Garlic (Allium sativum)

Allium sativum can be consumed in the form of tablets or capsules containing powder or oil, or else applied topically. Several medicinal properties have been reported, such as antimicrobial, anti-hypertensive, antithrombotic, antimutagenic and fibrinolytic effects, as well as glucose-reducing platelet activity. It is also indicated for decreasing cholesterol and treating arteriosclerosis1212 Nizarali N, Rafique S. Dental management of patients with drug-related acquired bleeding disorders. Dent Update. 2013;40(9):711-2.. However, its anticoagulant effect has been proven in studies that have demonstrated a reduction in platelet activity, leading to hemorrhage44 Shankland II WE. Four common herbs seen in dental practice: properties and potential adverse effects. Cranio. 2009;27(2):118-24.,1313 Borrelli F, Capasso R, Izzo AA. Garlic (Allium sativum L.): adverse effects and drug interactions in humans. Mol Nutr Food Res. 2007;51(11):1386-97. doi: 10.1002/mnfr.200700072
https://doi.org/10.1002/mnfr.200700072...
. This effect may be further heightened by its combined use with allopathic medications, such as acetylsalicylic acid, warfarin and other drugs1212 Nizarali N, Rafique S. Dental management of patients with drug-related acquired bleeding disorders. Dent Update. 2013;40(9):711-2.,1414 Heck AM, Dewitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7-1515 Little JW. Complementary and alternative medicine: impact on dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(2):137-45. doi: 10.1016/j.tripleo.2004.05.011
https://doi.org/10.1016/j.tripleo.2004.0...
.

Therefore, it is recommended that Allium sativum be suspended at least one week before a surgical dental procedure1010 Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-16. doi: 10.1001/jama.286.2.208
https://doi.org/10.1001/jama.286.2.208...
. In case of combined used with warfarin, this recommendation is even more important, because of the likelihood of high interaction55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
,1010 Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-16. doi: 10.1001/jama.286.2.208
https://doi.org/10.1001/jama.286.2.208...
.

Chilean boldo (Peumus boldus)

Concentrated Peumus boldus solution is widely used for the treatment of digestive and liver disorders55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
. However, its possible antiplatelet effects have already been described in the literature55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
,1616 Teng CM, Hsueh CM, Chang YL, Ko FN, Lee SS, Liu KCS. Antiplatelet effects of some aporphine and phenanthrene alkaloids in rabbits and man. J Pharm Pharmacol. 1997;49(7):706-11.-1717 Lambert JP, Cormier J. Potential interaction between warfarin and boldo-fenugreek. Pharmacotherapy. 2001;21(4):509-12. doi: 10.1592/phco.21.5.509.34492
https://doi.org/10.1592/phco.21.5.509.34...
. When Peumus boldus is used alone in high doses and/or in association with allopathic drugs, platelet dysfunctions may be even greater. Therefore, it is recommended that the use of Peumus boldus be suspended before performing surgical dental procedures1818 Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40..

Chamomile (Matricaria recutita)

Matricaria recutita can be used as an essential oil, in capsule or liquid form. It has several medicinal properties, such as anti-inflammatory, antispasmodic1818 Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40.-1919 Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401. doi: 10.1046/j.1365-2710.2002.00444.x
https://doi.org/10.1046/j.1365-2710.2002...
sedative and antiseptic effects. It is indicated for the treatment of flatulence, digestive disorders and nasal mucositis1919 Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401. doi: 10.1046/j.1365-2710.2002.00444.x
https://doi.org/10.1046/j.1365-2710.2002...
. However, Matricaria recutita also may act on platelet function, and consequently increase the risk of hemorrhage1111 Saw JT, Bahari MB, Ang HH, Lim YH. Potential drug-herb interaction with antiplatelet/anticoagulant drugs. Complement Ther Clin Pract. 2006;12(4):236-41. doi: 10.1016/j.ctcp.2006.06.002
https://doi.org/10.1016/j.ctcp.2006.06.0...
,1414 Heck AM, Dewitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7. Although cases of interaction with warfarin have already been reported as leading to hemorrhage2020 Segal R, Pilote L. Warfarin interaction with matricaria chamomilla. CMAJ. 2006;174(9):1281-2. doi: 10.1503/cmaj.051191
https://doi.org/10.1503/cmaj.051191...
, this link has not yet been clearly established. Nevertheless, because of its possible antiplatelet action and probable interaction with others drugs55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
,2020 Segal R, Pilote L. Warfarin interaction with matricaria chamomilla. CMAJ. 2006;174(9):1281-2. doi: 10.1503/cmaj.051191
https://doi.org/10.1503/cmaj.051191...
, its use should be suspended preventively prior to surgical dental procedures.

Indian horse chestnut (Aesculus hippocastanum)

Aesculus hippocastanum can be taken in the form of tablets, capsules, gels or creams. This substance is used as an adjuvant in capillary treatment, and for the treatment of varicose veins and hemorrhoids1818 Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40.-1919 Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401. doi: 10.1046/j.1365-2710.2002.00444.x
https://doi.org/10.1046/j.1365-2710.2002...
. It interferes with platelet function and with the coagulation action of warfarin55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
,2121 Ulbricht C, Tiffany N, Boon H, Ulbricht C, Basch E, Bent S, et al. Horse chestnut: a multidisciplinary clinical review. J Herb Pharmacother. 2002;2(1):71-85and other drugs1818 Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40.. Therefore, its use must be avoided before surgical dental procedures.

Ginkgo biloba (Gingko biloba)

Gingko biloba is a substance widely used by the population around the world in the form of gel and capsules to treat vascular disorders1818 Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40., aid cognitive development1414 Heck AM, Dewitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7, prevent dementia1212 Nizarali N, Rafique S. Dental management of patients with drug-related acquired bleeding disorders. Dent Update. 2013;40(9):711-2. and Alzheimer’s disease1010 Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-16. doi: 10.1001/jama.286.2.208
https://doi.org/10.1001/jama.286.2.208...
, and treat macular degeneration, tinnitus and erectile1010 Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-16. doi: 10.1001/jama.286.2.208
https://doi.org/10.1001/jama.286.2.208...
. Its antiplatelet action has already been reported11 Vaes LP, Chyka PA. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother. 2000;34(12):1478-82.

2 Wynn RL, Bergman SA. Drugs and herbal remedies that affect blood clotting. Gen Dent. 2002;50(6):484-8.

3 Varona F, Morales M. Ginkgo biloba y hemorragia cerebral. An Med Interna. 2005;22(4),199.

4 Shankland II WE. Four common herbs seen in dental practice: properties and potential adverse effects. Cranio. 2009;27(2):118-24.
-55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
, although there are controversies on this matter2222 Koch E. Inhibition of platelet activating factor (PAF)-induced aggregation of human thrombocytes by ginkgolides: considerations on possible bleeding complications after oral intake of Ginkgo biloba extracts. Phytomedicine. 2005;12(1-2):10-6. doi: 10.1016/j.phymed.2004.02.002
https://doi.org/10.1016/j.phymed.2004.02...
.

The anticoagulant effects of Ginkgo biloba have been reported mainly when this substance is used in combination with allopathic drugs, such as warfarin55 Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
https://doi.org/10.1155/2014/957362...
, heparin1818 Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40., aspirin11 Vaes LP, Chyka PA. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother. 2000;34(12):1478-82.,1111 Saw JT, Bahari MB, Ang HH, Lim YH. Potential drug-herb interaction with antiplatelet/anticoagulant drugs. Complement Ther Clin Pract. 2006;12(4):236-41. doi: 10.1016/j.ctcp.2006.06.002
https://doi.org/10.1016/j.ctcp.2006.06.0...
,1919 Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401. doi: 10.1046/j.1365-2710.2002.00444.x
https://doi.org/10.1046/j.1365-2710.2002...
,2323 Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med. 1997;336(15):1108. doi: 10.1056/NEJM199704103361518
https://doi.org/10.1056/NEJM199704103361...
, and ibuprofen2424 Meisel C, Johne A, Roots I. Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis. 2003;167(2):367. doi: 10.1016/S0021-9150(03)00015-7
https://doi.org/10.1016/S0021-9150(03)00...
. Therefore, dentists must be attentive to patients taking Ginkgo biloba, particularly when this substance is associated with other drugs of high hemorrhagic potential, before performing surgical procedures.

Ginseng (Panax ginseng)

Panax ginseng is used for preventing against states of physical and mental fatigue1818 Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40., for strengthening the immune system1919 Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401. doi: 10.1046/j.1365-2710.2002.00444.x
https://doi.org/10.1046/j.1365-2710.2002...
, for its aphrodisiac, antidepressant and diuretic properties, and for preventing cardiovascular disorders44 Shankland II WE. Four common herbs seen in dental practice: properties and potential adverse effects. Cranio. 2009;27(2):118-24.. Its interaction with warfarin has already been established2525 Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm. 1997 Mar 15;54(6):692-3.. However, some studies do not corroborate these findings2626 Jiang X, Williams KM, Liauw WS, Ammit AJ, Roufogalis BD, Duke CC, et al. Effect of St John's wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol. 2004;57(5):592-9. doi: 10.1111/j.1365-2125.2003.02051.x
https://doi.org/10.1111/j.1365-2125.2003...
-2727 Yuan CS, Wei G, Dey L, Karrison T, Nahlik L, Maleckar S, et al. Brief communication: American ginseng reduces warfarin's effect in healthy patients: a randomized, controlled trial Ann Intern Med. 2004;141(1):23-7.. Therefore, further studies are needed on this subject.

In brief, many studies have found scientific evidence regarding the antiplatelet properties or drug interactions regarding the substances addressed in this study. These properties and interactions have demonstrated the potentiation of their hemorrhagic effects. Therefore, preventive measures, clarification and monitoring of patients taking these substances are recommended before performing surgical dental procedures, in order to prevent against complications such as hemorrhage.

REFERENCES

  • 1
    Vaes LP, Chyka PA. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother. 2000;34(12):1478-82.
  • 2
    Wynn RL, Bergman SA. Drugs and herbal remedies that affect blood clotting. Gen Dent. 2002;50(6):484-8.
  • 3
    Varona F, Morales M. Ginkgo biloba y hemorragia cerebral. An Med Interna. 2005;22(4),199.
  • 4
    Shankland II WE. Four common herbs seen in dental practice: properties and potential adverse effects. Cranio. 2009;27(2):118-24.
  • 5
    Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med. 2014;2014:957362. doi: 10.1155/2014/957362
    » https://doi.org/10.1155/2014/957362
  • 6
    Winslow LC, Kroll DJ. Herbs as medicines. Arch Intern Med. 1998;158:2192-9.
  • 7
    Pribitkin EA. Herbal medicine and surgery. Sem Integ Med. 2005;3(1):17-23. doi: 10.1016/j.sigm.2005.01.005
    » https://doi.org/10.1016/j.sigm.2005.01.005
  • 8
    Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall T, Riggins CW, et al. The complete german commission e monographs: therapeutic guide to herbal. Austin: Am Botanical Council; 1988.
  • 9
    Bardia A, Nisly NL, Zimmerman MB, Gryzlak BM, Wallace RB. Use of herbs among adults based on evidence-based indications: findings from the National Health Interview Survey. Mayo Clin Proc. 2007;82(5):561-6. doi: 10.4065/82.5.561
    » https://doi.org/10.4065/82.5.561
  • 10
    Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-16. doi: 10.1001/jama.286.2.208
    » https://doi.org/10.1001/jama.286.2.208
  • 11
    Saw JT, Bahari MB, Ang HH, Lim YH. Potential drug-herb interaction with antiplatelet/anticoagulant drugs. Complement Ther Clin Pract. 2006;12(4):236-41. doi: 10.1016/j.ctcp.2006.06.002
    » https://doi.org/10.1016/j.ctcp.2006.06.002
  • 12
    Nizarali N, Rafique S. Dental management of patients with drug-related acquired bleeding disorders. Dent Update. 2013;40(9):711-2.
  • 13
    Borrelli F, Capasso R, Izzo AA. Garlic (Allium sativum L.): adverse effects and drug interactions in humans. Mol Nutr Food Res. 2007;51(11):1386-97. doi: 10.1002/mnfr.200700072
    » https://doi.org/10.1002/mnfr.200700072
  • 14
    Heck AM, Dewitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7
  • 15
    Little JW. Complementary and alternative medicine: impact on dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(2):137-45. doi: 10.1016/j.tripleo.2004.05.011
    » https://doi.org/10.1016/j.tripleo.2004.05.011
  • 16
    Teng CM, Hsueh CM, Chang YL, Ko FN, Lee SS, Liu KCS. Antiplatelet effects of some aporphine and phenanthrene alkaloids in rabbits and man. J Pharm Pharmacol. 1997;49(7):706-11.
  • 17
    Lambert JP, Cormier J. Potential interaction between warfarin and boldo-fenugreek. Pharmacotherapy. 2001;21(4):509-12. doi: 10.1592/phco.21.5.509.34492
    » https://doi.org/10.1592/phco.21.5.509.34492
  • 18
    Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL. Principais interações no uso de medicamentos fitoterápicos. Infarma. 2007;19(1/2):32-40.
  • 19
    Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27(6):391-401. doi: 10.1046/j.1365-2710.2002.00444.x
    » https://doi.org/10.1046/j.1365-2710.2002.00444.x
  • 20
    Segal R, Pilote L. Warfarin interaction with matricaria chamomilla. CMAJ. 2006;174(9):1281-2. doi: 10.1503/cmaj.051191
    » https://doi.org/10.1503/cmaj.051191
  • 21
    Ulbricht C, Tiffany N, Boon H, Ulbricht C, Basch E, Bent S, et al. Horse chestnut: a multidisciplinary clinical review. J Herb Pharmacother. 2002;2(1):71-85
  • 22
    Koch E. Inhibition of platelet activating factor (PAF)-induced aggregation of human thrombocytes by ginkgolides: considerations on possible bleeding complications after oral intake of Ginkgo biloba extracts. Phytomedicine. 2005;12(1-2):10-6. doi: 10.1016/j.phymed.2004.02.002
    » https://doi.org/10.1016/j.phymed.2004.02.002
  • 23
    Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med. 1997;336(15):1108. doi: 10.1056/NEJM199704103361518
    » https://doi.org/10.1056/NEJM199704103361518
  • 24
    Meisel C, Johne A, Roots I. Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis. 2003;167(2):367. doi: 10.1016/S0021-9150(03)00015-7
    » https://doi.org/10.1016/S0021-9150(03)00015-7
  • 25
    Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm. 1997 Mar 15;54(6):692-3.
  • 26
    Jiang X, Williams KM, Liauw WS, Ammit AJ, Roufogalis BD, Duke CC, et al. Effect of St John's wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol. 2004;57(5):592-9. doi: 10.1111/j.1365-2125.2003.02051.x
    » https://doi.org/10.1111/j.1365-2125.2003.02051.x
  • 27
    Yuan CS, Wei G, Dey L, Karrison T, Nahlik L, Maleckar S, et al. Brief communication: American ginseng reduces warfarin's effect in healthy patients: a randomized, controlled trial Ann Intern Med. 2004;141(1):23-7.

Publication Dates

  • Publication in this collection
    Apr-Jun 2017

History

  • Received
    22 Nov 2016
  • Reviewed
    16 Jan 2017
  • Accepted
    06 Apr 2017
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