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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Over-the-counter natural products in cardiac surgery: a case of ginseng-related massive perioperative bleeding
  1. Alessandro Viviano1,
  2. Duncan Steele2,
  3. Mark Edsell2,
  4. Marjan Jahangiri2
  1. 1 Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London, UK
  2. 2 Department of Cardiac Surgery, St George's Hospital, London, UK
  1. Correspondence to Professor Marjan Jahangiri, marjan.jahangiri{at}st.georges.nhs.uk

Summary

We present a case of massive perioperative bleeding due to severe coagulopathy following urgent aortic and mitral valve replacement. Bleeding was persistent despite prolonged and meticulous surgical haemostasis and required high-volume blood products transfusions. No obvious cause was found to justify the severity of the coagulopathy, which was later attributed to high preoperative intake of ginseng.

This case highlights the powerful activity of certain over-the-counter remedies on haemostasis, in this particular case on coagulation status. This also reminds us the paramount importance of a sound and comprehensive drug history for surgical patients.

  • Contraindications and precautions
  • Drugs and medicines
  • Pharmacology and therapeutics
  • Cardio thoracic surgery
  • Haematology

https://doi.org/10.1136/bcr-2016-218068

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    Footnotes

    • Contributors AV (first author) has developed the original idea further and wrote the manuscript.

      DS (coauthor) has mainly contributed with literature research and contributed in writing the manuscript.

      ME has contributed in highlighting the anaesthesiological perspective involving coagulation and haematological issues.

      MJ has formulated the original idea, supervised the entire process and reviewed and corrected the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.