Coagulation disorders

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Integrative therapies

• Strong scientific evidence:
• Policosanol: Policosanol is a natural product made from the waxy coating of sugar cane that helps lower cholesterol. Various studies have found that policosanol causes inhibition of platelet aggregation.
• Avoid if allergic or hypersensitive to policosanol. Use cautiously with nitrates, aspirin, or drugs that lower cholesterol or blood pressure. Avoid if pregnant or breastfeeding.
• Vitamin K: Vitamin K is found in green leafy vegetables, such as spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Vitamin K deficiency in infants may lead to hemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding (VKDB). Although almost half of newborns may have some degree of vitamin K deficiency, serious hemorrhagic disease is rare. Because vitamin K given by injection has been shown to prevent VKBD in newborns and young infants, the American Academy of Pediatrics recommends administering a single intramuscular injection of vitamin K1 to all newborns. Oral dosing is not considered adequate as prevention, particularly in breastfeeding infants. Initial concerns of cancer risk have not been proven and are generally not considered clinically relevant. In cases of true VKDB, bleeding may occur at injection sites, at the umbilicus, or in the gastrointestinal tract. Life-threatening bleeding into the head (intracranial) or in the area behind the lower abdomen (retroperitoneum) may also occur. Evaluation by a physician is imperative.
• Warfarin (Coumadin®) is a blood-thinning drug that inhibits vitamin K-dependent clotting factors. Warfarin is prescribed by doctors for people with various conditions, such as arterial fibrillation, artificial heart valves, history of serious blood clot, clotting disorders (hypercoagulability), or placement of indwelling catheters/ports. Usually, blood tests are done regularly to evaluate the extent of blood thinning, using a test for prothrombin time (PT) or International Normalized ratio (INR). The range for the PT/INR depends on the condition being treated. Elevated PT/INR may result from many causes and sometimes can be dangerously high and increase the risk of serious bleeding. Patients taking warfarin should be aware of these potential causes, which include many drugs that interact with warfarin, liver disorders, or accidental warfarin overdose. Because the effects of warfarin on anticoagulation are usually delayed several days, the PT/INR may not increase immediately at the time of overdose. If a person's blood becomes too "thin," treatment should be under strict medical supervision and may include oral or injected vitamin K to help reverse the effects of warfarin.
• Avoid if allergic or hypersensitive to vitamin K. Injection into the muscle or vein should only be done by a healthcare professional. Many serious side effects have occurred after injection. Menadiol, a type of vitamin K that is not available in the United States, should be avoided with glucose-6-phosphate dehydrogenase deficiency. Avoid if pregnant. Large amounts of vitamin K may cause serious side effects or death. Vitamin K is generally considered safe for breastfeeding mothers.
• Unclear or conflicting scientific evidence:
• Aortic acid: Aortic extract is usually made from the hearts of animals, usually sheep, cows, or pigs. There are many substances in this extract, including aortic acid, which is a broad term encompassing several constituents. Mesoglycan is the most studied of these constituents. Further research is needed to determine whether or not aortic acid may help treat patients with deep vein thrombosis (DVT).
• Allergic reactions have not been reported in the available literature. Due to the heparan sulfate content of mesoglycan, patients with an allergy to heparin or heparinoid derivatives should use caution. Use cautiously with coagulation (blood) disorders or in patients taking anticoagulation therapy. Use cautiously with hypertension (high blood pressure) or in patients taking antihypertensive drugs. Avoid if pregnant or breastfeeding.
• Garlic: The garlic bulb is made of many cloves that are wrapped in a paper-thin, white skin. Garlic, which is often used as a spice in food, has also been used to treat many medical conditions. In humans, garlic has been studied for its anti-platelet effects and potential use as an anticoagulant therapy. Because garlic has been associated with several cases of bleeding, therapy should be used cautiously, especially in patients who are taking other medications, herbs, or supplements that may increase the risk of bleeding.
• Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures to avoid bleeding problems. Avoid supplemental doses if pregnant or breastfeeding.
• Ginger: The underground stems (rhizomes) and above ground stems of ginger have been used in Chinese, Japanese, and Indian medicine for hundreds of years. One study suggests that ginger may increase the anti-platelet effects of the medication nifedipine in patients who have high blood pressure. Further research is necessary to determine if ginger might be used as an anticoagulant therapy.
• Avoid if allergic to ginger or other members of the Zingiberaceaefamily, including red ginger, Alpinia purpurata, shell ginger, Alpinia zeru, green cardamom, or Balsam of Peru. Use cautiously if driving or operating machinery because ginger may cause drowsiness. Stop two weeks before and immediately after surgery/dental/diagnostic procedures due to risk of bleeding. Avoid with a history of irregular heartbeat (arrhythmia). Use cautiously with a history of ulcers, acid reflux, heart conditions, inflammatory bowel disease, blocked intestines, or bleeding disorders. Use cautiously if pregnant or breastfeeding.
• Grape seed: Early human and animal studies show that extracts of grape seed may block the ability of platelets to form a clot (resulting in "thinner" blood). In clinical study, grape seed constituents have resulted in inhibition of platelet aggregation, however additional research is needed to better determine these effects and applicable patient populations.
• Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with drugs processed using the liver's "cytochrome P450" enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Avoid with disorders that increase the risk of bleeding or with active bleeding disorders (stomach ulcers, bleeding into the brain, etc.). Avoid if pregnant or breastfeeding.
• Pycnogenol: Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine (Pinus pinaster ssp. atlantica), which is grown in coastal southwestern France. Pycnogenol® contains oligomeric proanthocyanidins (OPCs), as well as several other bioflavonoids: catechin, epicatechin, phenolic fruit acids (such as ferulic acid and caffeic acid), and taxifolin. According to the results of limited available human study, Pycnogenol® may cause inhibition of platelet aggregation in smokers. However, further research is needed before a firm conclusion can be made.
• Pycnogenol® treatment may effectively decrease the number of thrombotic events (deep vein thrombosis and superficial vein thrombosis) in moderate- to high-risk subjects, during long-haul flights. Edema (swelling) may also be reduced. Further research is needed to confirm these results.
• Avoid if allergic or hypersensitive to Pycnogenol®, its components, or members of the Pinaceae family. Use cautiously with diabetes, hypoglycemia, bleeding disorders. Use cautiously if taking hypolipidemic agents (drugs that lower cholesterol), medications that may increase the risk of bleeding, hypertensive medications, or immune stimulating or inhibiting drugs. Avoid if pregnant or breastfeeding.
• Rutin: Rutin is a yellow crystalline flavonol glycoside that occurs in various plants, especially the buckwheat plant, black tea, apple peels, onions, and citrus. Limited available clinical study suggests that a rutin-containing drug called Venoruton®, in combination with elastic compression or thrombectomy, may offers benefit as compared to these treatments alone for patients with superficial vein thrombosis (SVT). Additional study is needed in this area.
• Avoid if allergic or hypersensitive to O-(beta-hydroxyethyl)-rutosides or plants that rutin is commonly found in, such as rue, tobacco, or buckwheat. Use cautiously in elderly patients. Use cautiously with skin conditions. Use cautiously if taking medications for edema, diuretics, or anticoagulation medications (e.g. heparin or warfarin). Use cautiously if pregnant or breastfeeding.
• Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, andit is often combined with bladderwrack in kelp preparations. Laboratory study has found anticoagulant properties in fucans or fucoidans, which are components of brown algae such as bladderwrack. However, there are no high quality human studies available to support this use.
• Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
• Shea butter: In clinical trials, shea butter/oil was shown to lower increases in postprandial factor VII coagulant concentrations. Additional trials with larger sample sizes are needed to confirm the anticoagulant effects of shea butter.
• Use cautiously in patients taking anticoagulants. Use cautiously in patients with a latex allergy as anecdotal information suggests that some formulations of shea butter may contain latex.
• TENS (transcutaneous electrical nerve stimulation): TENS (transcutaneous electrical nerve stimulation) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS has been suggested as a possible treatment for skin flap ischemia. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures, such as breast reconstruction. Currently, there is not enough reliable evidence to draw a firm conclusion in this area.
• Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as a nerve disorder called neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding.
• Turmeric: Early research suggests that turmeric may prevent the formation of blood clots. More research is needed before turmeric can be recommended for blood clot prevention.
• Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.
• Vitamin E: Preliminary data suggests that supplementation with vitamin E may reduce the risk of venous thromboembolism (VTE) in women, and those with a prior history or genetic predisposition may particularly benefit. Additional research is needed to confirm these results.
• Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid above the recommended daily level in pregnant women and breastfeeding women.
• Yohimbe bark extract: The terms yohimbine, yohimbine hydrochloride, and yohimbe bark extract are all related. However, they all have slightly different meanings. Yohimbine is found in the bark of the Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States. Pre-clinical studies report that yohimbine alkaloids, constituents of yohimbe bark, may cause inhibition of platelet aggregation. Research in humans is limited, and more research is necessary in this area.
• Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or any ingredients in yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease, or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or in pregnant or breastfeeding women.
• Fair negative scientific evidence:
• Boron: Boron is an element that is found around the world. Boron can enter the body through the skin, lungs, or mouth. It has been proposed that boron may affect the activity of certain blood clotting factors. Study results are conflicting and there is therefore currently not enough evidence to form a clear conclusion of boron's potential to cause prevention of blood clotting.
• Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate, or glycinate. Avoid with a history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions, such as breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.