Abstract
To describe a patient with loss of anticoagulation control and bleeding after consumption of the combination herbal product quilinggao. A 61-year-old man who was stable on warfarin therapy regularly consumed a jelly-like herbal product called quilinggao ("essence of tortoise shell"). Five days after the daily consumption of a second brand of quilinggao, he developed easy gum bleeding, epistaxis, and skin bruising with an international normalized ratio (INR) >6.0. Warfarin therapy was temporarily withdrawn until the INR decreased to 1.9. On the day of hospital discharge, he took a third brand of quilinggao against medical advice. Three days later, his INR was 5.2. Warfarin therapy was again temporarily withheld and the patient counseled about an apparent herb-warfarin interaction. He could not remember the name of the third brand of quilinggao. Quilinggao is a very popular Chinese herbal product. There are many different brands, and the composition of herbal products varies between manufacturers. Chuanbeimu (Fritillaria cirrhosa) in the first brand and beimu (Fritillaria spp.), chishao (Paeoniae rubra, Chinese peony), jinyinhua (Lonicera japonica), and jishi (Poncirus trifoliata) in the second brand of quilinggao have antiplatel...Continue Reading
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