Bleeding Risks Associated With Herbal Medicine in Children

Dear Editor, We read with great interest the article by Gardiner et al1 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.