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Herb Groups
Platelet Interactors
Botanicals

Definition

Platelet Aggregation Factor (PAF) Interactor Herbs

introduction:
A number of herbs have inhibitory effects on Platelet Aggregation Factor (PAF) or are antiaggregant due to other mechanisms, such as inhibition of arachadonic acid cascade induced aggregation and inhibition of cAMP by flavonoids. The majority of studies have been in vitro and on isolated constituents. Invariably, these herbs have several other activities, not only cardiovascular, some of which may also affect hemodynamics; see, for example, Allium sativum (Garlic), which combines cholesterolemic, rheostatic blood thinning, antiaggregant and fibrinolytic activities and Ginkgo biloba which is antioxidant, vasodilatory and neuroprotective.

interactions overview:
• herb group affecting drug performance: Heparin and Warfarin

• herb group affecting drug performance and toxicity: Aspirin and Ticlopidine

• herbal synergy: High Vitamin K

» Herbs:
herb group affecting drug performance: Heparin and Warfarin

• mechanism: Herbs that inhibit platelet aggregation may potentiate the anticoagulant activity of warfarin or similar drugs. Ginkgo inhibits platelet adhesion and can increase any tendency toward bleeding. Three case reports of warfarin and Ginkgo interactions include one of hyphema, one of subdural hemorrhage, and one of subarachnoid hemorrage.
(Rosenblatt M, Mindel J. 1997; Rowin J, Lewis SL.1996; Vale S. 1998.)

• herbal concern: Vigilant monitoring of PT/INR values with warfarin-using patients who consume Ginkgo extracts is essential.

herb group affecting drug performance and toxicity: Aspirin and Ticlopidine

• research: A recent animal study has shown also Ginkgo synergises with the PAF inhibitor, Ticlopidine. Generally, adverse effects are not likely to appear unless relatively large doses of these herbs or their combinations were consumed for an extended period of time.
(Kim YS, et al.Thromb Res 1998.Jul 1;91(1):33-38; Matthews MK Jr.Neurology 1998 Jun;50(6):1933-1934; Rosenblatt M, Mindel J. New Engl J Med 1997.336:1108; Rowin J, Lewis SL. Neurology 1996 Jun;46(6):1775-1776; Skogh M. Lancet. 1998 Oct 3;352(9134):1145-1146; Vale S, Lancet. 1998 Jul 4;352(9121):36.)

• herbal concern: Caution is also advised prior to surgical procedure, when failure of fibrinogenesis can be be potentially life-threatening. Patients scheduled for surgical procedures should advise their physicians if they are consuming PAF interactor herbs.

herbal synergy: Indirect interaction with other herbs from the following groups may take place through various synergistic physiologic mechanisms including High Vitamin K herbs.

Herbs with PAF agonism activity:
PAF agonism has not been found in many herbs; the hemostatic effects of antihemorrhagic and styptic herbs being due to other mechanisms such as tannin astringency rather than enhancement of coagulation. However, a few hemostatic herbs have been shown to reduce clotting times, e.g., Panax notoginseng (Tienchi Ginseng).

Common herbs with PAF inhibitory activity:
Allium cepa (Onion plant)
Allium sativum (Garlic)
Ananas comosus (Bromelain, from fruit and stem)
Andrographis paniculata (Chiretta, Andrographis)
Angelica sinensis (Dong Quai)
Capsicum frutescens (Cayenne fruit)
Carica papaya (Papain, from leaves and unripe fruit)
Coleus forskohlii (Coleus root)
Commiphora mukul (Guggul)
Coptis spp. (generic Goldenthread)
Curcuma longa, Curcuma aromatica (Turmeric root)
Ganoderma lucidum (Reishi mushroom fruiting bodies)
Ginkgo biloba (Ginkgo leaves)
Panax ginseng (Chinese Ginseng)
Paeonia lactiflora (White peony root)
Salvia miltiorrhiza (Dan Shen root)
Scutellaria baicalensis (Baical skullcap root)
Zingiber officinale (Ginger rhizome)

Restricted or unusual herbs with PAF inhibitory activity:
Cinchona spp.(Cinchona) toxic
Podophyllum peltatum (Mayapple) toxic

Herbs with proaggregatory activity:
Panax notoginseng (Tien Qi, Tienchi Ginseng)
Mahonia spp. (Oregon Grape root) - isolated berberine studies.
Hydrastis canadensis (Goldenseal rhizome) - isolated berberine studies.


Footnotes

Kim YS, et al. Antiplatelet and antithrombotic effects of a combination of ticlopidine and Ginkgo biloba extract. Thromb Res 1998;Jul 1;91(1):33-38.
Abstract: The antiplatelet and antithrombotic effects of the oral combination treatment of ticlopidine and Ginkgo biloba extract (EGb 761) were studied in normal and thrombosis-induced rats. The ex vivo inhibitory effect on ADP-induced platelet aggregation of a small dose of ticlopidine (50 mg/kg/day) in combination with EGb 761 (40 mg/kg/day) was comparable to a larger dose of only ticlopidine (200 mg/kg/day). Bleeding time was also prolonged by 150%. Thrombus weight was also consistently decreased by a combination of ticlopidine and EGb 761 in an arterio-venous shunt model at two doses of ticlopidine (50 mg/kg) plus EGb 761 (20 mg/kg) and ticlopidine (50 mg/kg) plus EGb 761 (40 mg/kg). A combinatory treatment in acute thrombosis model in mice also showed a higher recovery than a single treatment.

Matthews MK. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998 Jun;50(6):1933-1934. (Letter)

Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion. Neurology 1996Jun;46(6):1775-1776.

Skogh M. Extracts of Ginkgo biloba and bleeding or haemorrhage. Lancet 1998 Oct; 3, 352 (9134):1145-1146.

Vale S. Subarachnoid haemorrhage associated with Ginkgo biloba . Lancet 1998 Jul4;352(9121):36.