Question of the Week # 49

A 45 year old woman presents to your clinic with history of intermittent epistaxis. Of late, this has become more frequent. The patient has a history of atrial fibrillation for which she has been taking aspirin as recommended by her cardiologist. She has no other past medical history. The patient also takes over the counter medications such as Vitamin b-complex which she thinks keeps her from getting tired. She says she also takes about 4 grams of Omega 3 fatty acids to keep “her heart healthy” and Ginkgo biloba to slow the “ageing of her brain”. Her laboratory tests reveal normal complete blood count. Prothrombin time and partial thromboplastin time are with in normal limits. Which of the following is your next step in managing this patient’s recurrent epistaxis?

A. Advise her to discontinue omega 3 fatty acids.
B. Discontinue Aspirin
C. Advise her to stop both Omega 3 fatty acids and Ginkgo biloba
D. Advise her to stop Ginkgo biloba
E. Advise her to stop Vitamin B-complex

2 Responses

  1. D

  2. Ans. C

    Advise to discontinue both omega 3 fatty acids and ginkgo biloba ( Ans. C). Ginkgo biloba potentiates aspirin by increasing the bleeding time. Omega 3 fatty acids in large doses can also prolong the bleeding time by decreasing the platelet aggregation. Since this patient is having recurrent epistaxis, it is advisable to discontinue both of them at this time and observe.

    Ans. A is sub-optimal management.

    Ans. B is incorrect. The patient has “lone” atrial fibrillation and she requires aspirin to reduce her stroke risk.

    Ans. D is sub-optimal management.

    Ans. E is incorrect. B-complex has no effect on bleeding time or platelet aggregation.

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