Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2016

Open Access 01-12-2016 | Research article

Effects of naturopathic medicines on Multiplate and ROTEM: a prospective experimental pilot study in healthy volunteers

Authors: August Bagge, Ulf Schött, Thomas Kander

Published in: BMC Complementary Medicine and Therapies | Issue 1/2016

Login to get access

Abstract

Background

Of patients undergoing surgery, 22 to 57 % have been reported to be using naturopathic medicines. Several of these medicines have been reported to increase bleeding or enhance the effect of other drugs that increase bleeding. The Swedish Medical Products Agency recommends cessation of the use of the naturopathic medicines echinacea, fish oil, ginkgo biloba, ginseng, St. John’s wort, valeriana and garlic 2 weeks before surgery. The aim of this pilot study was to examine the effects of these 7 naturopathic medicines in healthy humans by utilising multiple electrode aggregometer (Multiplate) and viscoelastic rotational thromboelastometer (ROTEM) to obtain data for sample size calculation before a larger trial.

Methods

Thirty-five healthy volunteers ingested one of the listed naturopathic medicines for 7 days. Each naturopathic medicine was taken in a recommended standard dose by 5 volunteers. ROTEM clot initiation (CT), clot formation (CFT), α-angle (AA) and clot structure (MCF) were analysed with tissue factor activated (EXTEM) and native (NATEM) assays. The Multiplate platelet aggregation area under curve (AUC) was measured with adenosine diphosphate (ADP), collagen (COL) and arachidonic acid (ASPI) assays.

Results

Multiplate with ADP agonist decreased from 73 ± 8.7 AUC to 60 ± 5.9 AUC (P = 0.003, 95 % confidence interval (CI) −19.2 to −7.6) after medication with fish oil, but fish oil had no effect on COL or ASPI reagents. None of the other naturopathic medicines had any effect on Multiplate aggregometry. ROTEM NATEM-CFT increased from 217 ± 32 s to 283 ± 20 (P = 0.009, 95 % CI 26.8 to 107), and NATEM-AA decreased from 52 ± 3.9° to 44 ± 2.3° (P = 0.009, 95 % CI −12.0 to −3.2) after medication with fish oil. There were no significant changes in the other NATEM or EXTEM parameters. The other naturopathic medicines had no significant effects on ROTEM or Multiplate aggregometry.

Conclusions

We have demonstrated that a recommended standard intake of 1260 mg Ω-3 polyunsaturated fatty acids (fish oil) daily – but not echinacea, ginkgo biloba, ginseng, St. John’s wort, valeriana or garlic – may decrease platelet aggregation and clot formation. A larger trial in this setting would be meaningful to perform.

Trial registration

Trial registration ISRCTN78027929. Registered 19 May 2015.
Literature
1.
Adusumilli PS, Ben-Porat L, Pereira M, Roesler D, Leitman IM. The prevalence and predictors of herbal medicine use in surgical patients. J Am Coll Surg. 2004;198(4):583–90.CrossRefPubMed
2.
Hodges PJ, Kam PCA. The peri-operative implications of herbal medicines. Anaesthesia. 2002;57(9):889–99.CrossRefPubMed
3.
Kleinschmidt S, Rump G, Kotter J. Herbal medications: possible importance for anaesthesia and intensive care medicine. Anaesthesist. 2007;56(12):1257–66.CrossRefPubMed
4.
5.
6.
Violi F, Pignatelli P, Basili S. Nutrition, supplements, and vitamins in platelet function and bleeding. Circulation. 2010;121(8):1033–44.CrossRefPubMed
7.
Bordia A, Verma SK, Srivastava KC. Effect of garlic on platelet aggregation in humans: a study in healthy subjects and patients with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids. 1996;55(3):201–5.CrossRefPubMed
8.
Legnani C, Frascaro M, Guazzaloca G, Ludovici S, Cesarano G, Coccheri S. Effects of a dried garlic preparation on fibrinolysis and platelet aggregation in healthy subjects. Arzneimittelforschung. 1993;43(2):119–22.PubMed
9.
Wojcikowski K, Myers S, Brooks L. Effects of garlic oil on platelet aggregation: a double-blind placebo-controlled crossover study. Platelets. 2007;18(1):29–34.CrossRefPubMed
10.
Ali M, Thomson M. Consumption of a garlic clove a day could be beneficial in preventing thrombosis. Prostaglandins Leukot Essent Fatty Acids. 1995;53(3):211–2.CrossRefPubMed
11.
McEwen BJ, Morel-Kopp MC, Chen W, Tofler GH, Ward CM. Effects of omega-3 polyunsaturated fatty acids on platelet function in healthy subjects and subjects with cardiovascular disease. Semin Thromb Hemost. 2013;39(1):25–32.CrossRefPubMed
12.
Nomura S, Kanazawa S, Fukuhara S. Effects of eicosapentaenoic acid on platelet activation markers and cell adhesion molecules in hyperlipidemic patients with Type 2 diabetes mellitus. J Diabetes Complications. 2003;17(3):153–9.CrossRefPubMed
13.
Takada K, Ishikawa S, Yokoyama N, Hosogoe N, Isshiki T. Effects of eicosapentaenoic acid on platelet function in patients taking long-term aspirin following coronary stent implantation. Int Heart J. 2014;55(3):228–33.CrossRefPubMed
14.
Turner JM, Field CJ, Goruk S, Wizzard P, Dicken BJ, Bruce A et al. Platelet Arachidonic Acid Deficiency May Contribute to Abnormal Platelet Function During Parenteral Fish Oil Monotherapy in a Piglet Model. JPEN J Parenter Enteral Nutr. 2015. Epub ahead of print.
15.
Johansson PI, Stensballe J, Oliveri R, Wade CE, Ostrowski SR, Holcomb JB. How I treat patients with massive hemorrhage. Blood. 2014;124(20):3052–8.CrossRefPubMed
16.
17.
Ganter MT, Hofer CK. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg. 2008;106(5):1366–75.CrossRefPubMed
18.
Da Luz L, Nascimento B, Shankarakutty A, Rizoli S, Adhikari N. Effect of thromboelastography (TEG(R)) and rotational thromboelastometry (ROTEM(R)) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review. Crit Care. 2014;18(5):518.CrossRefPubMedPubMedCentral
19.
Veljovic M, Mihajlovic I, Subota V, Antunovic M, Jevdjic J, Udovicic I, et al. Effect of pretreatment with omega-3 polyunsaturated fatty acids (PUFAs) on hematological parameters and platelets aggregation in patients during elective coronary artery bypass grafting. Vojnosanit Pregl. 2013;70(4):396–402.CrossRefPubMed
20.
McEwen BJ. The influence of diet and nutrients on platelet function. Semin Thromb Hemost. 2014;40(2):214–26.CrossRefPubMed
21.
Michelson AD. Platelets. 3rd ed. London: Elsevier; 2013. p. 51–66.
22.
Mizia-Stec K, Mizia M, Haberka M, Lasota B, Gieszczyk-Strozik K, Chmiel A, et al. N-3 polyunsaturated fatty acids do not influence the efficacy of dual antiplatelet therapy in stable angina pectoris patients after percutaneous coronary intervention. Cardiol J. 2013;20(5):478–85.CrossRefPubMed
23.
Vilahur G, Badimon L. Antiplatelet properties of natural products. Vascul Pharmacol. 2013;59(3–4):67–75.CrossRefPubMed
24.
Watson PD, Joy PS, Nkonde C, Hessen SE, Karalis DG. Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel-versus-aspirin + clopidogrel in patients with cardiovascular disease. Am J Cardiol. 2009;104(8):1052–4.CrossRefPubMed
25.
Wachira JK, Larson MK, Harris WS. N-3 fatty acids affect haemostasis but do not increase the risk of bleeding: clinical observations and mechanistic insights. Br J Nutr. 2014;111(9):1652–62.CrossRefPubMed
26.
Gorlinger K, Dirkmann D, Hanke AA. Potential value of transfusion protocols in cardiac surgery. Curr Opin Anaesthesiol. 2013;26(2):230–43.CrossRefPubMed
27.
Afshari A, Wikkelso A, Brok J, Moller AM, Wetterslev J. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev. 2011;3, CD007871.
28.
29.
Hanke AA, Roberg K, Monaca E, Sellmann T, Weber CF, Rahe-Meyer N, et al. Impact of platelet count on results obtained from multiple electrode platelet aggregometry (Multiplate). Eur J Med Res. 2010;15(5):214–9.PubMedPubMedCentral
30.
Stissing T, Dridi NP, Ostrowski SR, Bochsen L, Johansson PI. The influence of low platelet count on whole blood aggregometry assessed by multiplate. Clin Appl Thromb Hemost. 2011;17(6):E211–7.CrossRefPubMed
31.
Wurtz M, Hvas AM, Kristensen SD, Grove EL. Platelet aggregation is dependent on platelet count in patients with coronary artery disease. Thromb Res. 2012;129(1):56–61.CrossRefPubMed
32.
Srivastava KC. Evidence for the mechanism by which garlic inhibits platelet aggregation. Prostaglandins Leukot Med. 1986;22(3):313–21.CrossRefPubMed
33.
Chang HS, Yamato O, Sakai Y, Yamasaki M, Maede Y. Acceleration of superoxide generation in polymorphonuclear leukocytes and inhibition of platelet aggregation by alk(en)yl thiosulfates derived from onion and garlic in dogs and humans. Prostaglandins Leukot Essent Fatty Acids. 2004;70(1):77–83.CrossRefPubMed
34.
Kiesewetter H, Jung F, Jung EM, Mrowietz C, Koscielny J, Wenzel E. Effect of garlic on platelet aggregation in patients with increased risk of juvenile ischaemic attack. Eur J Clin Pharmacol. 1993;45(4):333–6.CrossRefPubMed
35.
Scharbert G, Kalb ML, Duris M, Marschalek C, Kozek-Langenecker SA. Garlic at dietary doses does not impair platelet function. Anesth Analg. 2007;105(5):1214–8.CrossRefPubMed
36.
Zhou Q, Jiang L, Xu C, Luo D, Zeng C, Liu P, et al. Ginsenoside Rg1 inhibits platelet activation and arterial thrombosis. Thromb Res. 2014;133(1):57–65.CrossRefPubMed
37.
Hong JM, Shin DH, Lim YA, Lee JS, Joo IS. Ticlopidine with Ginkgo Biloba extract: a feasible combination for patients with acute cerebral ischemia. Thromb Res. 2013;131(4):e147–53.CrossRefPubMed
38.
Messina BAM. Herbal supplements: facts and myths-talking to your patients about herbal supplements. J Perianesth Nurs. 2006;21(4):268–78.CrossRefPubMed
39.
Shalansky S, Lynd L, Richardson K, Ingaszewski A, Kerr C. Risk of warfarin-related bleeding events and supratherapeutic international normalized ratios associated with complementary and alternative medicine: a longitudinal analysis. Pharmacotherapy. 2007;27(9 I):1237–47.CrossRefPubMed
40.
Lee A, Chui PT, Aun CST, Lau ASC, Gin T. Incidence and risk of adverse perioperative events among surgical patients taking traditional chinese herbal medicines. Anesthesiology. 2006;105(3):454–61.CrossRefPubMed
41.
Kepler CK, Huang RC, Meredith D, Kim JH, Sharma AK. Omega-3 and fish oil supplements do not cause increased bleeding during spinal decompression surgery. J Spinal Disord Techniques. 2012;25(3):129–32.CrossRef
42.
Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14(5):365–76.CrossRefPubMed
Metadata
Title
Effects of naturopathic medicines on Multiplate and ROTEM: a prospective experimental pilot study in healthy volunteers
Authors
August Bagge
Ulf Schött
Thomas Kander
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2016
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-016-1051-y

Other articles of this Issue 1/2016

BMC Complementary Medicine and Therapies 1/2016 Go to the issue

Research article

Complementary and alternative medicine: attitudes, knowledge and use among surgeons and anaesthesiologists in Hungary

Research article

Antioxidant activities and oxidative stress inhibitory effects of ethanol extracts from Cornus officinalis on raw 264.7 cells

Research article

Rhus verniciflua Stokes (RVS) and butein induce apoptosis of paclitaxel-resistant SKOV-3/PAX ovarian cancer cells through inhibition of AKT phosphorylation

Research article

Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application

Research article

The influence of goutweed (Aegopodium podagraria L.) tincture and metformin on the carbohydrate and lipid metabolism in dexamethasone-treated rats

Research article

Clinical effects of a standardized Chinese herbal remedy, Qili Qiangxin, as an adjuvant treatment in heart failure: systematic review and meta-analysis