Herbal products and supplements. Herbal products and supplements often affect platelet aggregation and the coagulation cascade by means that cannot be detected by laboratory tests. The increasing popularity of these unregulated products requires screening patients for their use. There are limited studies regarding the use of herbal supplements in neurosurgery and, as a precaution for an elective operation, waiting 7–14 days after cessation of their use is suggested. Fish Oil (Omega-3 Fatty Acids) is used for the treatment of dyslipidemia and hypertriglyceridemia. Fish oil may affect platelet aggregation by a reduction in arachidonic acid and thromboxane and adenosine diphosphate receptor blockade. Fish oil may also potentially lengthen bleeding times.
Garlic (Allium sativum): purported benefits include lowering blood pressure, preventing infection and myocardial infarction, and treating hypercholesterolemia. Garlic has an antiplatelet effect through ADP receptor blockade, and reducing calcium and thromboxane.
Garlic may potentiate the the antiplatelet or anticoagulant effect of aspirin or warfarin.
Ginkgo (Ginkgo biloba) is found in many formulations from capsules to energy drinks. It has been used to treat memory loss, depression, anxiety, dizziness, claudication, erectile dysfunction, tinnitus, and headache. Ginkgo affects bleeding via an antiplatelet effect and antagonism of platelet-activating factor.
Ginseng (Panax ginseng) also has antiplatelet activity through thromboxane inhibition and platelet-activating factor.32 Some authors also advocate cautious use of ginger and vitamin E when planning surgery, but the exact antiplatelet mechanism is unclear.