Bleeding Risks of Herbal, Homeopathic, and Dietary Supplements: A Hidden Nightmare for Plastic Surgeons?

Abstract

The utilization of complementary and alternative medicine has increased tremendously in the last two decades. Herbal products, homeopathic medicines, and dietary supplements are extremely popular and are available without a prescription (which likely contributes to their popularity). Despite their "natural" characteristics, these remedies have the potential to cause bleeding in patients who undergo surgery. The high use of these supplements among cosmetic surgery patients, coupled with increasing reports of hematomas associated with herbal and homeopathic medicines, prompted the authors to conduct a comprehensive review focused on bleeding risks of such products in an effort to raise awareness among plastic surgeons. This review focuses on 19 herbs, three herbal formulas, two herbal teas, and several other supplements that can cause bleeding perioperatively and postoperatively. In addition to being aware of such adverse effects, plastic surgeons must adequately screen all patients and educate them on the possible dangers associated with these treatments.

Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

“…Most notably, the perioperative use of herbal therapies such as A montana (wolfsbane, leopard bane, mountain tobacco) or bromelain (pineapple extract [Ananas sativus]) has increased, with goals of alleviating perioperative ecchymosis and edema and accelerating wound healing, respectively. 15,16 Scientific studies surrounding A montana have produced equivocal results. Negative findings include those of a placebo-controlled study 17 investigating the effects of topical A montana on ecchymoses after laser treatment, which revealed no difference from placebo in the reduction of ecchymoses.…”

Managing antiplatelet and anticoagulant drugs in patients undergoing elective ophthalmic surgery

“…Box 1 outlines the common risk factors to consider during preoperative assessment.

The risk factors of intraoperative and postoperative haemorrhage in ophthalmic surgery40 History of bleeding disorders or thromboembolic events Liver failure, renal failure or anaemia41 Cardiac stent Uncontrolled hypertension Herbal treatments like feverfew, garlic, ginger, ginkgo and Asian ginseng42 43 Family history of bleeding or clotting disorders

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Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery

“…78 Most of those supplements have potential for perioperative bleeding, sedation, or hypertension (Table 1), and should therefore be discontinued 2 to 3 weeks preoperatively. [78][79][80] …”