Coltsfoot as a potential cause of deep vein thrombosis and pulmonary embolism in a patient also consuming kava and blue vervain.

OBJECTIVE: To report a case of deep vein thrombosis (DVT) with symptomatic pulmonary embolism (PE) possibly associated with the use of coltsfoot, kava, or blue vervain. CASE SUMMARY: A 27-year-old white male presented with leg pain and swelling, tachycardia, and pleuritic chest pain. He had no significant medical history. A medication history revealed extensive herbal medication use including: coltsfoot, passionflower, red poppy flower petals, wild lettuce, blue lily flowers, wild dagga flowers, Diviners Three Burning Blend® (comprised of salvia divinorum, blue lily, and wild dagga), kava-kava, St. John's Wort, blue vervain, and Dreamer's Blend® (comprised of Calea zacatechichi, vervain, Entada rheedii, wild lettuce, and Eschscholzia californica). Lower extremity Doppler ultrasound and computed topography (CT) of the chest revealed DVT and PE. A hypercoagulable work-up was negative. The patient was treated with enoxaparin and warfarin and was discharged home. DISCUSSION: While no distinct agent can be identified as a sole cause of this venous thromboembolic event, coltsfoot could potentially affect coagulation through its effect on vascular endothelial cells as they regulate nitric oxide. Nitric oxide is a known mediator of platelet activity and coagulation, particularly in the pulmonary vasculature. Kava and vervain have estrogenic properties. CONCLUSIONS: Of the medications consumed by this self-proclaimed "herbalist," coltsfoot is a potential cause of venous thromboembolic disease (VTE).

[Herbs on the Internet: risky information]. / Erbe in Internet: informazioni a rischio.

We analyzed Internet information about herbal products and dietary supplements regulated by Ministry of Public Health. We screened 522 Italian web sites and we found information about toxic risks on Germander (Teucrium chamaedrys), Red yeast fermented rice (Monascus ruber), Borage (Borago officinalis) and Coltsfoot (Tussilago farfara) respectively in: 63%, 47%, 3% and 22% of the web sites. It is also possible the on-line purchase. Results show that in Internet there are not correct instructions about risks of herbal products.