Since these medications appear to impair coagulation how can their effect be evaluated clinically

The best means for detecting a coagulation defect secondary to herbal medications is a properly taken clinical history. Especially important are questions related to the hemostatic response during previous surgeries. Also important are questions regarding bleeding tendencies such as easy bruising, gingival bleeding, or excessive bleeding following procedures such as dental extractions. Positive responses suggest the need for laboratory testing. The most commonly used measures of coagulation include the activated partial thromboplastin time, which evaluates the intrinsic system, the prothrombin time, which evaluates the extrinsic pathway, platelet count, and bleeding time. However, bleeding time, the most commonly used measure of platelet function, is subject to many variables and may not always be reliable. More reliable tests of platelet function are available but are expensive, time-consuming, and not appropriate for routine screening.

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