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Interaction between warfarin and the herbal product Shengmai-yin: a case report of intracerebral hematoma.

Su Q, Li Y - Yonsei Med. J. (2010)

Bottom Line: He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions.Shengmai-yin contains herbal ingredients that can interact with warfarin.Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

ABSTRACT
A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

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Preoperative computed tomography scans showing left frontoparietal hematoma with midline shift.
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Figure 1: Preoperative computed tomography scans showing left frontoparietal hematoma with midline shift.

Mentions: A 71-year-old man was admitted to the intensive care unit following consciousness disturbance for 5 hours. His initial Glasgow Coma Scale (GCS) score was 7. He had right hemiplegia and active pupils, 3 mm on the two sides. Head computed tomography (CT) on admission showed an intracerebral hemotoma in the left temporoparietal region causing marked midline shift to the right, and a tubular high-density area in the left temporal lobe (Fig. 1). Laboratory studies revealed prothrombin time (PT) was prolonged to 66 seconds with an international normalized ratio (INR) 5.08. Renal and liver function tests were normal. Chest X-ray revealed no abnormality.


Interaction between warfarin and the herbal product Shengmai-yin: a case report of intracerebral hematoma.

Su Q, Li Y - Yonsei Med. J. (2010)

Preoperative computed tomography scans showing left frontoparietal hematoma with midline shift.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908877&req=5

Figure 1: Preoperative computed tomography scans showing left frontoparietal hematoma with midline shift.
Mentions: A 71-year-old man was admitted to the intensive care unit following consciousness disturbance for 5 hours. His initial Glasgow Coma Scale (GCS) score was 7. He had right hemiplegia and active pupils, 3 mm on the two sides. Head computed tomography (CT) on admission showed an intracerebral hemotoma in the left temporoparietal region causing marked midline shift to the right, and a tubular high-density area in the left temporal lobe (Fig. 1). Laboratory studies revealed prothrombin time (PT) was prolonged to 66 seconds with an international normalized ratio (INR) 5.08. Renal and liver function tests were normal. Chest X-ray revealed no abnormality.

Bottom Line: He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions.Shengmai-yin contains herbal ingredients that can interact with warfarin.Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

ABSTRACT
A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

Show MeSH
Related in: MedlinePlus