{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:12:38Z","timestamp":1784621558502,"version":"3.55.0"},"reference-count":10,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,3,23]]},"abstract":"<jats:p>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.<\/jats:p><jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2016-218068","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T10:04:39Z","timestamp":1556705079000},"page":"bcr-2016-218068","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Over-the-counter natural products in cardiac surgery: a case of ginseng-related massive perioperative bleeding"],"prefix":"10.1136","volume":"2017","author":[{"given":"Alessandro","family":"Viviano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"Steele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Edsell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjan","family":"Jahangiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,7]]},"reference":[{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.athoracsur.2016.05.023","article-title":"Effects of blood transfusion on cause-specific late mortality after coronary artery bypass grafting-less is more","volume":"102","author":"Schwann","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3390\/medicines2030157","article-title":"Commonly used dietary supplements on coagulation function during surgery","volume":"2","author":"Wang","year":"2015","journal-title":"Medicines"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.3","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/j.1476-5381.2012.01967.x","article-title":"Ginsenoside-Rp1 inhibits platelet activation and thrombus formation via impaired glycoprotein VI signaling pathway, tyrosine phosphorylation and MAPK activation","volume":"167","author":"Endale","year":"2012","journal-title":"Br J Pharmacol"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.4","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3109\/13880209.2013.775164","article-title":"A comparative study on anticoagulant activities of three chinese herbal medicines from the genus Panax and anticoagulant activities of ginsenosides Rg1 and Rg2","volume":"51","author":"Li","year":"2013","journal-title":"Pharm Biol"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.5","first-page":"1047","article-title":"Comparative study on effects of active ingredients of several traditional Chinese medicines on rabbit platelet aggregatiom in vivo","volume":"12","author":"Wu","year":"2007","journal-title":"Chin J Clin Pharm Ther"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.6","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-1-200407060-00011"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.7","doi-asserted-by":"publisher","DOI":"10.1177\/0091270011407194"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.8","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1111\/bcp.13080","article-title":"Effect of fermented red ginseng on cytochrome P450 and P-glycoprotein activity in healthy subjects, as evaluated using the cocktail approach","volume":"82","author":"Kim","year":"2016","journal-title":"Br J Clin Pharmacol"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.9","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200522060-00006"},{"key":"2025042712245932000_2017.aug07_1.bcr-2016-218068.10","unstructured":"Panax ginseng . Natural medicines (database on the internet). Somerville (MA)\u00a0: Therapeutic Research Center, 2017. https:\/\/naturalmedicines.therapeuticresearch.com. (accessed 29 Jan 2017)."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-218068","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T19:25:09Z","timestamp":1745781909000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-218068"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,7]]},"references-count":10,"alternative-id":["10.1136\/bcr-2016-218068"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-218068","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,7]]}}}