Bleeding risks associated with herbal medicine in children.

Dear Editor,

We read with great interest the article by Gardiner et al[1] discussing adverse events associated with herbal medicine use in children and wish to congratulate the authors on highlighting potentially harmful effects of herbal medicine use. We also wish to raise awareness of the anti-thrombotic properties of commonly used herbal medications such as ginkgo, omega-3 oils, vitamin E, feverfew, and dong quai, which may potentiate the anticoagulant properties of prescribed medication and have been linked to hemorrhagic central nervous system and surgical complications.[2-4] Furthermore, the unregulated nature of the herbal medicine industry has particular implications for children who may be vulnerable to toxic doses per unit mass due to altered or immature drug metabolism and lower body weight.[5] We advise and practice an inquiry about herbal medicine use in all children undergoing surgical procedures and have an open discussion about their continuance with regards to minimising the risks of hemorrhagic complications.

Author Response

Thank you for bringing attention to the anti-thrombotic properties of some herbal medications. Currently, there is no clinical research on how anti-thrombotic properties of herbal medicines affect children and whether these properties are different in infants, children, and adolescents. Many plants demonstrate anti-coagulant properties in animal or in vitro studies, and it is unknown how these properties affect children or children who take medications. Furthermore, children have different metabolism, absorption, dietary preferences, and lower body weight compared to adults, making it difficult to apply the findings of anti-coagulant herbal studies to children. As for regulation, another complexity is the variable types of regulation, types of products, and dosing of herbal products around the globe. I do agree that it is wise to inquire about herbal medicine use in all children during a medical visit or in those undergoing surgical procedures and to discuss the risks and benefits of herbal products with their families.