Newer Hemostatic Agents Used in the Practice of Dermatologic Surgery

Table 3

Dietary supplements and anticoagulant properties.

Type of supplement	Mechanism of action	Comments
Garlic	Allicin, adenosine, and paraffinic sulfide in garlic inhibit platelet aggregation, increasing bleeding time [26, 27].	Should be used in caution in conjunction with other anticoagulants such as Coumadin and heparin [27].
Ginkgo-biloba	Inhibits platelet activating factor [26]. Platelet aggregation thought to be inhibited by terpene ginkgolide B [24, 28].	Discontinue 36 hours before surgery [27]. One energy drink contains more than recommended dosage [28]. Caution should be used when combining with Cilostazil [28]. Some studies have shown no increase in bleeding when compared to a placebo [29].
Ginseng	Inhibits platelet aggregation by altering inhibiting thromboxane function [24, 27].	Large ingredient in energy drinks.
Ginger	Gingerol in ginger inhibits platelet function by inhibiting platelet activation also decreases synthesis of thromboxane [24, 27].	Has not shown to interact with NSAIDs or warfarin. More studies need to be performed on the extent of ginger’s anticoagulant properties.
Vitamin E	Decreased platelet adhesion and aggregation [24].	Anticoagulant properties are dosedependent. Because it is a fat soluble vitamin, large doses can be stored in the body causing toxicity as well as increased propensity to bleed [27].
Omega-3-fish oil	Decreased platelet adhesion and aggregation [24].	Has not been shown to increase bleeding complications in spinal surgery [30]. In conjunction with other anticoagulant medications, may lead to increased effect [27].