MAJOR — Use With Caution
DANGEROUS — additive anticoagulant/antiplatelet effect; significant bleeding risk
Evidence level: STRONG
Dong quai contains blood-thinning compounds similar to warfarin — together they can cause dangerous bleeding.
Dong quai contains natural coumarins and may inhibit platelet aggregation. Combined with warfarin, significantly increases bleeding risk. Case reports of severe INR elevation.
Do NOT take dong quai while on warfarin. Discontinue dong quai and inform anticoagulation clinic. INR should be rechecked after stopping.
Use caution. Many botanicals affect blood clotting — ginkgo, garlic, ginger, turmeric, and dong quai all have antiplatelet activity that can amplify Warfarin. 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 anticoagulant/antiplatelet therapy, bleeding disorders, surgery planned
Unusual bruising, nosebleeds, blood in urine/stool, prolonged bleeding from cuts, heavy menstrual bleeding
CRITICAL: Stop dong quai and inform anticoagulation clinic immediately.
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 contains blood-thinning compounds similar to warfarin — together they can cause dangerous bleeding.
Use caution. Many botanicals affect blood clotting — ginkgo, garlic, ginger, turmeric, and dong quai all have antiplatelet activity that can amplify Warfarin. 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, nosebleeds, blood in urine/stool, prolonged bleeding from cuts, heavy menstrual 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.
CRITICAL: Stop dong quai and inform anticoagulation clinic immediately.
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