MODERATE — Monitor Closely
CAUTION — additive bleeding risk
Evidence level: MODERATE
Dong quai may increase bleeding risk with Xarelto.
Dong quai antiplatelet activity may add to rivaroxaban anticoagulant effect.
Avoid combining or inform prescriber.
Use caution. Many botanicals affect blood clotting — ginkgo, garlic, ginger, turmeric, and dong quai all have antiplatelet activity that can amplify Rivaroxaban. St. John's Wort can REDUCE anticoagulant effectiveness. Take at separate times and inform your prescriber about all herbal supplements. Request more frequent INR monitoring if on warfarin.
Concurrent anticoagulants, bleeding history
Unusual bruising, prolonged bleeding
Disclose herbal supplement use to prescriber.
Blood thinners have narrow safety margins. Instead of Dong Quai, consider safer options: CoQ10 (with INR monitoring), vitamin D3, or probiotics — these have minimal anticoagulant interactions. Always inform your anticoagulation clinic about any supplements.
Dong quai may increase bleeding risk with Xarelto.
Use caution. Many botanicals affect blood clotting — ginkgo, garlic, ginger, turmeric, and dong quai all have antiplatelet activity that can amplify Rivaroxaban. St. John's Wort can REDUCE anticoagulant effectiveness. Take at separate times and inform your prescriber about all herbal supplements. Request more frequent INR monitoring if on warfarin.
Unusual bruising, prolonged bleeding
Blood thinners have narrow safety margins. Instead of Dong Quai, consider safer options: CoQ10 (with INR monitoring), vitamin D3, or probiotics — these have minimal anticoagulant interactions. Always inform your anticoagulation clinic about any supplements.
Disclose herbal supplement use to prescriber.
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