Yup.
Herbals are medications. In general, ones which are “heart healthy” and help you with atherosclerotic disease, peripheral vascular disease, impotence, or have anticoagulation properties = MAKE YOU BLEED. Seems obvious, but sometimes it is hard to think herbals are medications, and you may be taking an herbal for a different effect, like depression, and not know it is also an anticoagulant.
Common ones:
GARLIC
No, if you eat garlic bread at dinner you aren’t going to bleed to death if you get a cut (even if you go to the Stinking Rose in San Francisco). Garlic has been used as a medical remedy for thousands of years. It lowers cholesterol, reduces blood pressure, and inhibits thrombus formation (it inhibits platelets which help blood clot). The risk is dose dependent. Again, the amount in food is low. You are at risk if you take a specific supplement.
GINGKO BILOBA
Gingko comes from a unique species of tree located in China. It was thought to be extinct, but preserved by cultivation by Chinese monks for 1000 years. Gingko is used for a grab bag of indications, including improving memory and concentration, vertigo, dementia / Alzheimers, MS, and blood flow / microcirculation. Some of its effect is due to improving microcirculation and its antioxidant properties. Again, like garlic, it impedes platelet formation of clots.
GINSENG
Yes. The G herbals make you bleed. Ginseng is a staple of Chinese and Native American medicine. It is supposed to help the body fight stress and increase energy. It is also thought to help with libido and other hormonal and reproductive issues.
Issues for surgery? It has been said to increase coagulation time. Also, it may decrease blood glucose, which can be an issue for surgery patients who are not allowed to eat prior to surgery, particularly in diabetics. It can also interact with other drugs, including insulin, NSAIDs, anticoagulation drugs, blood pressure medications, and MAO inhibitors.
GINGER:
Thought to help with digestion and as a stimulant. It prolongs the action of some anticoagulation medications, and is supposed to have blood thinning capabilities.
ST. JOHN’S WORT
This drug is commonly used to treat depression. In some countries it is a prescription. ?It is thought to have anticoagulation properties. It is well known to cause increased metabolism of drugs and increased liver activity. This can lead to medications used in surgery not being at the appropriate level, as they are metabolized too quickly (and for you younger women out there, this includes birth control pills! women experience breakthrough bleeding because the blood levels of the birth control pill are too low). And in some medications like Plavix (a blood thinner) it amplifies the medication, causing an increase in bleeding time.
OTHERS
Alfalfa, capsicum, celery, chamomile, Chinese herbs, fenugreek, feverfew, fish oil, ginger, ginseng, horseradish, kava, licorice, passionflower, red clover and Vitamin E, meadowsweet, willow bark, tumeric, and bilberry.
There was a case report on echinacea- commonly used for colds- which caused bleeding in a woman who used it chronically. How? Her chronic use likely lead to liver issues, which caused the bleeding problem.
SO.
Remember herbals are medications. Tell your doctor what you are on, and likely stop them for two weeks ahead of surgery (at least if you are my patient). But that extra piece of garlic bread is okay.