Use of Complementary and Alternative Medicine Prior to Surgery Poses Risk to Patient Safety
Study Shows Patients at Risk by Not Telling Surgeons About Alternative Medicine Use
Sep 1, 2000
A new study by Columbia Presbyterian researchers cautions patients about to undergo cardiac surgery on the risk for potential adverse reactions from the use of alternative and complementary medicines. The study, reported in the August issue of The Journal of Thoracic and Cardiovascular Surgery, suggests that because the use of complementary and alternative medicine is so prevalent, health care providers should be aware of the serious implications for patient safety, especially in acute care situations.
Dr. Mehmet Oz, associate professor of surgery at Columbia University College of Physicians & Surgeons, and colleagues surveyed 376 mostly white, male, well-educated patients undergoing pre- or post-operative evaluations at Columbia Presbyterian Medical Center. Dr. Oz noted that a large proportion of these patients were using complementary and alternative medicine therapies, but only a few patients were willing to discuss the use with their doctors. Excluding those who turned only to prayer or to vitamins – the most popular therapies – 44 percent were found to have used some type of complementary and alternative treatments. Of that number, only 17 percent said they discussed the use of complementary and alternative medicine with their physicians, and 48 percent said they did not want to discuss the topic at all.
"Patients don't even want to talk about it," said Dr. Oz, "and so the physician may not be able to anticipate any adverse reactions that may result."
Several case reports have highlighted the dangers of herbal medicine, and the American Society of Anesthesiologists recently recommended that all herbal therapy be stopped two weeks before surgery. The study provides examples of several herbs that have been shown either to directly affect bleeding time or interact with anticoagulation medications. Garlic and onion, for example, inhibit platelet aggregation. Feverfew, ginkgo biloba, coenzyme Q10, ginger, ginseng, and St. Johns wort interact with warfarin, a blood thinner. Hawthorn berry, kyushin, licorice, plantain, uzara root, ginseng, and St. Johns wort interact with digoxin, a common heart medication. In addition, fish oils affect platelet aggregation and vitamin E affects platelet function.
Alternative medicine use in the survey was at about the level reported for the general population. Among the demographic variables measured – gender, age, race, marital status, and education – no significant correlation was found with the use of alternative medicine.
"As new research expands our understanding of the benefits and dangers of alternative therapies, physicians and patients must be open in their discussion of alternative therapy use," says Dr. Oz. The study was funded by the department of cardiothoracic surgery at Columbia Presbyterian Medical Center and Pure World Incorporated.