tribulus and Acute-Coronary-Syndrome

Nowadays, herbal combinations are commonly used in Turkey and around the world. In particular, an herbal combination including Tribulus terrestris (TT), Avena sativa (AS), and Panax Ginseng (PG), which may be effective in treatment of atherosclerosis and thrombosis, is used by patients with coronary artery disease. In this paper, we will report three cases with coronary stents who were diagnosed with acute coronary syndrome while using this herbal combination of TT, AS and PG together with anti-aggregant medications. A 45-year-old man presented with chest pain and coronary angiography confirmed a total occluded stent in left anterior descending artery which was implanted a year ago. Balloon dialation was performed to dilate the stent, resulting in full opening of the vessel. The second case, a 53-year-old woman, was admitted to the hospital with chest pain. Coronary angiography confirmed a total occluded stent, which had been implanted three months ago. A balloon was performed to dilate the stent and it was fully opened. The third case, a 62-year-old man, presented with chest pain. Coronary angiography was performed and there was a 98% stenosis of the circumflex stent, which was implanted three months ago. A balloon was performed to dilate the stent and it was fully opened. It was learnt that all three patients had used the same herbal combination (TT, AS and PG) with dual anti-aggregant therapy for three months ago to presentation in the clinic. Patients were discharged with the suggestion not to use this herbal combination with dual anti-aggregant therapy. There were no problems during the four month follow-up period. Stent thrombosis may be caused by interactions between herbal combination (TT, AS and PG) and clopidogrel in these patients under dual antiaggregant therapy.

Topics: Acute Coronary Syndrome; Angioplasty, Balloon, Coronary; Aspirin; Avena; Chest Pain; Clopidogrel; Coronary Angiography; Coronary Vessels; Female; Humans; Male; Middle Aged; Panax; Platelet Aggregation Inhibitors; Stents; Thrombosis; Ticlopidine; Tribulus

Atherosclerotic cardiovascular disease is an epidemic in today's world. It is one of the most common causes of hospitalization and death. Therefore, remedies to control or heal the disease are continuously sought. In addition to scientifically researched therapies, patients frequently utilize alternative medicine. However, effective and toxic doses, metabolisms, and drug interactions of the herbs and herbal nutrition supplements are largely unknown. Herein, we present two cases with acute coronary syndrome. The first case was admitted with a diagnosis of acute inferior myocardial infaction (MI) and a stent was implanted to the occluded right coronary artery (RCA). There was a 50% stenosis in his left anterior descending artery (LAD). He was admitted with a diagnosis of non-ST elevation MI (NSTEMI) 6 months later. In the coronary angiogram, there was stent restenosis in RCA, the lesion in LAD had become thrombotic and progressed to a stenosis of 90%. He was referred to surgical revascularization. The second case was admitted for acute inferior MI and a stent was implanted to the occluded circumflex artery. Two months later, he was hospitalized for NSTEMI. Progression of coronary plaques to stenosis and stent restenosis was detected and he was referred to surgical revascularization. Both patients used the product sold as Clavis Panax, which contains panax ginseng, tribulus terrestris, and oat, after their first coronary intervention. Intake of a mixture of plant extracts may have serious consequences in humans as drug interactions and side effects are unknown.

Topics: Acute Coronary Syndrome; Avena; Coronary Angiography; Coronary Stenosis; Humans; Inferior Wall Myocardial Infarction; Male; Middle Aged; Panax; Plant Extracts; Stents; Tribulus