Protoflow and Blood Thinners

Because the gap between too little and too much effect is small, and a bleed or a clot can be serious.

Warfarin, aspirin, clopidogrel and newer drugs such as apixaban each work in a different way, but all are sensitive to anything that changes clotting or platelets. A supplement that nudges either one can tip the balance. That is the reason prescribers ask about herbs at every visit.

Warfarin needs regular INR blood tests, and a new supplement can move the number up or down.

Ginkgo and vitamin E could raise bleeding risk, while ginseng could lower the drug's effect. The directions are opposite, which makes the result hard to predict. A man on warfarin should talk to the anticoagulation clinic before trying the blend, and should expect extra INR checks if the prescriber agrees.

• Nosebleeds that do not stop
• Gums that bleed easily
• Large or unexplained bruises
• Blood in urine, or black or bloody stools
• Sudden severe headache or vision change

Seek emergency care for heavy bleeding, head injury or a sudden severe headache while on a blood thinner.

Tell the surgeon or dentist that you take the blend, because ginkgo and vitamin E are on the list of supplements to review before procedures.

Many teams ask patients to pause herbal products for one to two weeks beforehand. The right interval depends on the operation, so follow the team's advice. Bring the label with you so the full ingredient list is visible.

Ask first, and treat the blend as a caution for anyone on an anticoagulant or antiplatelet drug. A call to the prescriber takes minutes, and the answer may spare you a bleed, an extra blood test or a wasted bottle, all of which cost more than the call.

Your prescription takes priority over a supplement every time.