Use of herbal medicinal products, herbal medicinal devices and dietary supplements prior to a planned surgical procedure. Part I. Ingredients of herbal medicines and dietary supplements increasing the risk of bleeding

Abstract

Subject of the study. Both herbal medicines and dietary supplements, as well as some medical devices intended for oral use, have significant biological activity and, therefore, may have potential multi-directional side effects during surgery. Relatively few doctors ask about the use of phytopharmaceuticals and dietary supplements, and the vast majority of patients do not disclose this information to them in the interview. The mechanisms of adverse interactions between concurrently used drugs and products and the resulting clinical effects are not fully understood, but most of them are pharmacodynamic and pharmacokinetic mechanisms leading to changes in the action of synthetic drugs (intensification or reduction of their therapeutic effect). One of the most serious side effects of herbal medicines and dietary supplements that may occur in the perioperative period is excessive bleeding. It may result from the content of biologically active compounds that have antithrombotic properties and inhibit platelet aggregation or have fibrinolytic activity. Purpose of the study. The aim of the study was to collect and systematize knowledge on the impact of the use of herbal medicines, herbal medical devices and dietary supplements before planned surgery on the risk of bleeding. For selected plant raw materials and ingredients of dietary supplements, the mechanisms of action and the time recommended for discontinuation before surgery were also determined, which will allow pharmacists and doctors to use the collected information in practice. Materials and methods. The literature review was performed by searching scientific databases: PubMed, Medline and Google Scholar. The search for relevant articles on herbal medicines, herbal medical devices and dietary supplements and their impact on coagulation processes was carried out using the keywords "herbal substances/phytopharmaceuticals", "dietary supplements", "coumarins”, "salicylates", "bleeding", "surgery", and then: "coagulation", "platelet aggregation". The methodology used allowed for the selection of, both original and review works from years 1995-2023, on the impact of the use of herbal medicines, herbal medical devices and dietary supplements on the risk of bleeding in the perioperative period. Results. The study presents suggested mechanisms of action and the time for discontinuing phytopharmaceuticals or dietary supplements containing ingredients that may increase the risk of bleeding as a result of interactions with drugs used before, during or after surgery. Conclusions. Physicians and patients should be aware of the potential adverse effects resulting from the use of phytopharmaceuticals or dietary supplements in the perioperative period, especially with regard to the coagulation system and platelet function. It is therefore important to obtain information from the patient about the use of these products before surgery and to include these informations in the medical documentation, which will help avoid unwanted reactions in the perioperative period