The Influence of Herbal Medicine on Platelet Function and Coagulation: A Narrative Review

Abstract

Cardiovascular disease (CVD) is the leading cause of death worldwide. Platelet activation and aggregation play a central role in hemostasis and thrombosis. Herbal medicines have been traditionally used in the management of CVD and can play a role in modifying CVD progression, particularly in platelet function, and have the potential of altering platelet function tests, as well as some coagulation parameters. Herbal medicines, such as feverfew, garlic, ginger, ginseng, motherwort, St John's wort, and willow bark, were found to reduce platelet aggregation. In vitro studies show promise in the reduction of platelet aggregation for Andrographis, feverfew, garlic, ginger, Ginkgo, ginseng, hawthorn, horse chestnut, and turmeric. In addition, cranberry, danshen, dong quai, Ginkgo, ginseng, green tea, and St John's wort were found to have potential interactions with warfarin. Furthermore, St John's wort interacted with clopidogrel and danshen with aspirin. Therefore, repeat testing of platelet function and coagulation studies, particularly for patients on warfarin therapy, may be required after exclusion of herbal medicines that could have possibly affected initial test results.

High proportion of patients with bleeding of unknown cause in persons with a mild‐to‐moderate bleeding tendency: Results from the Vienna Bleeding Biobank (VIBB)

“…Still, an influence of other comedications or dietary habits on platelet function cannot be ruled out completely. [37][38][39][40][41] To overcome this limitation, a confirmed PFD was only diagnosed in case of repeated abnormalities in the LTA aggregation curves ≥2 agonists at at least 2 different time points.…”

Management of severe perioperative bleeding

“…476 A recent narrative review provides an exhaustive list of the potential effects on haemostasis of different herbal medicines. 477 Many of them reduce platelet aggregation in vitro. In addition, some interact with antiplatelet and anticoagulant drugs.…”

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