Dietary Supplements and Bleeding

ABSTRACT

An estimated one third of United States adults use herbal supplements, often without reporting use to their physicians. These supplements can potentially alter bleeding and coagulation during surgery, and when used concomitantly with anticoagulants. Our objective is 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 are 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 non-essential supplement use 2 weeks prior to surgery.

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Faculty credentials/disclosure 

Dr. Reed and Dr. Dhir are residents in internal medicine at Baylor Scott & White Medical Center – Temple. Dr. Widmer is an interventional cardiologist at Baylor Scott & White Medical Center – Temple. The authors and planner for this educational activity have no relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.

Process

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Expiration date:

Credit eligibility for this article is set to expire on November 1, 2024.

Target Audience

All physicians

Learning Objectives

After completing the article, the learner should be able to:

    • Review with the patient a current list of herbal supplements the patient may not have disclosed, expecially before procedures and when patients are on anticoagulants
    • Differentiate between those dietary supplements for which there is high-level evidence of a bleeding risk and those supplements that should be approached with caution due to lack of substantial literature
    Course summary
    Available credit: 
    • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
      Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
    • 1.00 AMA PRA Category 1 Credit
      The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
    • 1.00 Attendance
    Course opens: 
    11/01/2022
    Course expires: 
    11/01/2024
    Cost:
    $25.00
    Rating: 
    0

    Accreditation

    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Designation

    AMA PRA Category 1 Credit

    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    American Board of Internal Medicine Maintenance of Certification (MOC)

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 MOC point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Available Credit

    • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
      Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
    • 1.00 AMA PRA Category 1 Credit
      The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
    • 1.00 Attendance

    Price

    Cost:
    $25.00
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