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Ginger-associated overanticoagulation by phenprocoumon.

Patricia Krüth¹, Eberhard Brosi, Richard Fux

¹Department of Clinical Pharmacology, Institute for Pharmacology and Toxicology, University Hospital Tübingen, Tübingen, Germany.

The Annals of Pharmacotherapy

|January 27, 2004

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This case report details a probable interaction between ginger and phenprocoumon, leading to an elevated international normalized ratio (INR) and bleeding. Discontinuing ginger normalized the INR, highlighting potential risks with herbal supplements during anticoagulation therapy.

Area of Science:

Pharmacology
Herbal Medicine Interactions
Clinical Case Reports

Background:

Phenprocoumon is an oral anticoagulant used to prevent blood clots.
Ginger is a common herbal supplement with potential effects on hemostasis.
Conflicting data exists regarding ginger's impact on platelet function and bleeding risk.

Observation:

A 76-year-old woman on phenprocoumon experienced a significant increase in her international normalized ratio (INR) up to 10.
The patient also developed epistaxis (nosebleeds) after initiating ginger product use.
INR levels returned to the therapeutic range after discontinuing ginger and administering vitamin K1.

Findings:

This case suggests a probable interaction between ginger and phenprocoumon, increasing the anticoagulant effect.

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The interaction led to a dangerously elevated INR and clinically significant bleeding (epistaxis).

This is the first reported case linking ginger consumption to adverse effects in a patient on oral anticoagulation.

Implications:

Patients on anticoagulants, particularly coumarins, should exercise caution with ginger and other herbal supplements.
Healthcare providers should inquire about herbal product use in patients experiencing anticoagulation-related adverse events.
Further research is needed to elucidate the mechanisms and clinical significance of ginger-anticoagulant interactions.