What herbal and vitamin supplements increase the risk of bleeding? Believe it or not, the list is longer than you’d expect and the risk is real. Herbal supplements can impact surgery in various ways, from additive sedation to increased bleeding risk. It’s important that the entire team be aware ahead of time, but patients don’t usually disclose herbal supplements because they may not consider them to be medications. So how are you screening your patients and mitigating this risk?
Medication reconciliation is important at all times, but especially so perioperatively. Screening for the use of herbal supplements is a must, especially since nearly half of all Americans take an herbal or dietary supplement. Do you know which ones can increase risk of bleeding?
Millions of Americans use herbal supplements for various perceived benefits such as improving memory, immune function or decreasing anxiety and cholesterol. In India and China herbal medicines are important parts of medical practice. Most people think because herbals are plant based, they are safe, even if not effective, but it’s not that simple. Plant based medications have been used since nearly the beginning and today some of our most common medications, such as morphine and aspirin, have their origins in plants. However, these medications are studied and then reviewed and approved by the U.S. Food & Drug Administration (FDA) if proven to be safe and effective. The same cannot be said for dietary supplements such as herbal treatments.
Because herbals are considered dietary supplements, they do not undergo the same FDA scrutiny medications are subjected to. This, in turn, makes it harder for both patients and providers to know about safety with any certainty. Herbal supplements need to meet certain quality standards and the FDA can remove dangerous products from the market, but manufacturer’s do not need FDA approval to market their products. Choosing products that have been tested by the U.S. Pharmacopeia and NSF International helps increase the likelihood that it’s safe, but it does not guarantee it…caution is still advised.
Dietary supplements that can increase bleeding risk:
There are many dietary supplements (herbals and vitamins) that can increase bleeding risk. This list is not comprehensive, but it addresses the most common culprits. For specific guidance, check with your consultant pharmacist.
- Dong Quai
- Feverfew
- Ginkgo Biloba
- Vitamin E (high dose)
- Garlic (high dose)
- Ginseng
- Ginger
- Omega-3-fatty acid (high dose)
It is generally suggested that patients disclose all supplements being taken well in advance of their surgery so the surgeon and anesthesia team can provide proper guidance on what and when to stop. Many organizations, including the American Society of Anesthesiologists advise that all herbal supplements be stopped at least two weeks before surgery. This generally provides a long enough “wash-out” period so that by the time the surgery takes place, the supplements are less likely to have adverse consequences such as increased bleeding time or sedation.
The perioperative risk of dietary supplements don’t stop with increased bleeding time. They can also prolong the effects of anesthesia, raise blood pressure, and interact with other medications being administered during the procedure. It’s critically important for the team to have a complete medication and supplement history to ensure patient safety and positive outcomes.
If you have questions about supplements and their impact on surgery or if you need assistance setting up proper medication reconciliation to meet regulatory requirements, contact us.
The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.
