Intraoperative Bleeding Associated with Preoperative Use of Ganoderma lucidum Supplements

Reishi mushroom, also known as Ganoderma lucidum, is a type of edible medicinal fungi that is found throughout Asia. The fruiting body (above-ground part) and mycelium (filaments connecting a group of mushrooms) are used as medicine. Recent research has shown that it may also have antiplatelet activity that is similar to aspirin. Likewise simvastatin has been shown to inhibit platelet aggregation. In addition, montelukast has anecdotally related to one case of acquired thrombopathia and may interfere with platelet aggregation.

In this paper, the authors reported a case of intraoperative hemorrhage with laparoscopic trocar placement and dissection in a patient concomitantly taking Ganoderma lucidum supplements, simvastatin and montelukast, all of which had a possible anticoagulant effect. The patient was a 64-year-old Vietnamese female. Patient had a past medical history of asthma, hypertension and dyslipidemia for which she took montelukast, albuterol, captopril and simvastatin. And she denied taking any supplements. Her preoperative coagulation studies were all within normal limits as the prothrombin time was 12.7 (control 12.1 - 14.8), partial thrombolplastin time was 34.0 (control 24.0 - 34.2) and the INR was 0.9. Her preoperative platelet count was 219,000. After surgery, she had post-operative bleeding from the wound edges that required cautery for hemostasis, which the surgeons believed was consistent with a platelet defect. She had no other further episodes of bleeding. Postoperatively, upon further questioning, she admitted to have been taking two Ganoderma products which she had denied to the involved clinicians preoperatively. And finally, the authors hypothesized that the patient’s platelets may have had a qualitative platelet defect because of the simultaneous use of montelukast, simvastatin and ganoderma supplements. More patients are utilizing herbal. 

In short, Reishi Mushroom products should be taken with caution in patients before surgery especially those who are taking other drugs with anti-platelet effects. It’s believed that a reasonable precaution would be to avoid the use of Ganoderma lucidum products for seven days prior to surgery if the patient is also taking simvastatin, montelukast or an anticoagulant.

Article by Steven Shulman, et al, from Rutgers New Jersey Medical School, Newark, USA.

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