Over-the-counter natural products in cardiac surgery: a case of ginseng-related massive perioperative bleeding

BMJ Case Rep. 2017 Aug 7:2017:bcr2016218068. doi: 10.1136/bcr-2016-218068.


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.

Keywords: Cardio thoracic surgery; Contraindications and precautions; Drugs and medicines; Haematology; Pharmacology and therapeutics.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Blood Coagulation Disorders / chemically induced*
  • Female
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Humans
  • Panax / adverse effects*
  • Postoperative Complications / chemically induced*
  • Postoperative Hemorrhage / chemically induced*