by Eric Yarnell, ND, RH(AHG), copyright 2024
Summary
Existing human studies demonstrate that turmeric and curcumin do not affecting clotting factors or platelet aggregation. The studies that have been done show that curcumin does not interact with common anticoagulants or antiplatelet drugs.
Effects on Bleeding
There are no published human studies regarding the effect of Curcuma longa (turmeric) or curcumin on clotting factors or platelets.
In a double-blind, randomized clinical trial of 54 American women with etonogestrel contraceptive implant-associated bleeding, curcumin in lipid nanospheres 600 mg qd had no effect on bleeding (Edelman 2023). It neither increased nor decreased bleeding.
Two patients with ulcerative proctocolitis had dramatic improvement taking a combination of curcumin and natural indigo (qing dai), rather than increased rectal bleeding (Ben-Horin 2022). A double-blind, randomized trial in 42 Israeli patients with ulcerative proctocolitis found the same results: curcumin-qing dai improved the condition and reduced or eliminated bleeding.
In a double-blind, randomized clinical trial of 54 American women with etonogestrel contraceptive implant-associated bleeding, curcumin in lipid nanospheres 600 mg qd had no effect on bleeding (Edelman 2023). It neither increased nor decreased bleeding.
Two patients with ulcerative proctocolitis had dramatic improvement taking a combination of curcumin and natural indigo (qing dai), rather than increased rectal bleeding (Ben-Horin 2022). A double-blind, randomized trial in 42 Israeli patients with ulcerative proctocolitis found the same results: curcumin-qing dai improved the condition and reduced or eliminated bleeding.
Effects on Anticoagulant/Antiplatelet Drugs
There are few published human studies regarding the effect of Curcuma longa (turmeric) or curcumin on anticoagulant or antiplatelet drugs. In one study in 10–16 Italian adults with cardiovascular disease taking aspirin, clopidogrel, or warfarin, 1 g of a curcumin-phospholipid complex had no interaction with this drug (Hu 2018). In a double-blind, randomized trial, 160 mg curcumin in a nano-micellar extract had no interaction with heparin in 40 Iranian adults with CoVid-19 infection (Hassaniazid 2021).
One case study reported a 74-year-old man with diabetes mellitus, hypertension, chronic atrial fibrillation, ischemic heart disease status post coronary artery bypass grafting and repeated angioplasties, end-stage renal failure status post kidney transplant, who developed a leg hematoma after taking curcumin 1 g per day (Gronich 2022). He was taking clopidogrel, apixaban, bisoprolol, doxazosin, lercanidipine, repaglinide, atorvastatin with ezetimibe, furosemide, prednisone, mycophenolic acid, tacrolimus, omeprazole, tamsulosin, dutasteride, and dipyrone. The hematoma developed 1 wk after starting the curcumin, which the patient stopped. A case study cannot prove a causal connection, but in patients with extreme circumstances such as this, curcumin may not be the most prudent treatment. Similarly, 48 Iranian patients with periodontal disease only had reduced gingival bleeding taking nanomicellular curcumin 80 mg qd (Malekzadeh 2021).
Curcumin at a dose of 100 mg/kg (but not less than this) increased absorption of warfarin and clopidogrel in rats, but this did not lead to significant changes in the prothrombin time or platelet aggregation (Liu 2013).
Curcuma zanthorrhiza (Java turmeric) extract at a dose of 18 mg/kg increased the absorption of R- and the far more active S-warfarin, but by <10%, in rats (Rusdiana 2021).
One case study reported a 74-year-old man with diabetes mellitus, hypertension, chronic atrial fibrillation, ischemic heart disease status post coronary artery bypass grafting and repeated angioplasties, end-stage renal failure status post kidney transplant, who developed a leg hematoma after taking curcumin 1 g per day (Gronich 2022). He was taking clopidogrel, apixaban, bisoprolol, doxazosin, lercanidipine, repaglinide, atorvastatin with ezetimibe, furosemide, prednisone, mycophenolic acid, tacrolimus, omeprazole, tamsulosin, dutasteride, and dipyrone. The hematoma developed 1 wk after starting the curcumin, which the patient stopped. A case study cannot prove a causal connection, but in patients with extreme circumstances such as this, curcumin may not be the most prudent treatment. Similarly, 48 Iranian patients with periodontal disease only had reduced gingival bleeding taking nanomicellular curcumin 80 mg qd (Malekzadeh 2021).
Curcumin at a dose of 100 mg/kg (but not less than this) increased absorption of warfarin and clopidogrel in rats, but this did not lead to significant changes in the prothrombin time or platelet aggregation (Liu 2013).
Curcuma zanthorrhiza (Java turmeric) extract at a dose of 18 mg/kg increased the absorption of R- and the far more active S-warfarin, but by <10%, in rats (Rusdiana 2021).
References
Ben-Horin S, Kopylov U, Salomon N (2022) "Curcumin-qingdai combination as treatment for moderate-severe ulcerative colitis" Case Rep Gastroenterol 16(3):563–8.
Ben-Horin S, Salomon N, Karampekos G, et al. (2024) "Curcumin-qingdai combination for patients with active ulcerative colitis: A randomized, double-blinded, placebo-controlled trial" Clin Gastroenterol Hepatol 22(2):347–56.e6.
Edelman A, Boniface E, Schrote K, et al. (2023) "Treatment of unfavorable bleeding patterns in contraceptive implant users: a randomized clinical trial of curcumin" Am J Obstet Gynecol 229(2):145.e1–145.e9.
Hassaniazad M, Eftekhar E, Inchehsablagh BR, et al. (2021) "A triple-blind, placebo-controlled, randomized clinical trial to evaluate the effect of curcumin-containing nanomicelles on cellular immune responses subtypes and clinical outcome in COVID-19 patients" Phytother Res 35(11):6417–27.
Gronich N, Hurani H, Weisz I, Halabi S (2022) "Spontaneous bleeding and curcumin: Case report" Open J Clin Med Case Reports: 8(16):1911.
Hu S, Belcaro G, Dugall M, et al. (2018) "Interaction study between antiplatelet agents, anticoagulants, thyroid replacement therapy and a bioavailable formulation of curcumin (Meriva®)" Eur Rev Med Pharmacol Sci 22(15):5042–6.
Liu AC, Zhao LX, Lou HX (2013) "Curcumin alters the pharmacokinetics of warfarin and clopidogrel in Wistar rats but has no effect on anticoagulation or antiplatelet aggregation" Planta Med 79(11):971–7.
Malekzadeh M, Kia SJ, Mashaei L, Moosavi MS (2021) "Oral nano-curcumin on gingival inflammation in patients with gingivitis and mild periodontitis" Clin Exp Dent Res 7(1):78–84.
Rusdiana T, Mardhiani YD, Putriana NA, et al. (2021) "The influence of Javanese turmeric (Curcuma xanthorrhiza [sic]) on the pharmacokinetics of warfarin in rats with single and multiple-dose studies" Pharm Biol 59(1):639–46.
Ben-Horin S, Salomon N, Karampekos G, et al. (2024) "Curcumin-qingdai combination for patients with active ulcerative colitis: A randomized, double-blinded, placebo-controlled trial" Clin Gastroenterol Hepatol 22(2):347–56.e6.
Edelman A, Boniface E, Schrote K, et al. (2023) "Treatment of unfavorable bleeding patterns in contraceptive implant users: a randomized clinical trial of curcumin" Am J Obstet Gynecol 229(2):145.e1–145.e9.
Hassaniazad M, Eftekhar E, Inchehsablagh BR, et al. (2021) "A triple-blind, placebo-controlled, randomized clinical trial to evaluate the effect of curcumin-containing nanomicelles on cellular immune responses subtypes and clinical outcome in COVID-19 patients" Phytother Res 35(11):6417–27.
Gronich N, Hurani H, Weisz I, Halabi S (2022) "Spontaneous bleeding and curcumin: Case report" Open J Clin Med Case Reports: 8(16):1911.
Hu S, Belcaro G, Dugall M, et al. (2018) "Interaction study between antiplatelet agents, anticoagulants, thyroid replacement therapy and a bioavailable formulation of curcumin (Meriva®)" Eur Rev Med Pharmacol Sci 22(15):5042–6.
Liu AC, Zhao LX, Lou HX (2013) "Curcumin alters the pharmacokinetics of warfarin and clopidogrel in Wistar rats but has no effect on anticoagulation or antiplatelet aggregation" Planta Med 79(11):971–7.
Malekzadeh M, Kia SJ, Mashaei L, Moosavi MS (2021) "Oral nano-curcumin on gingival inflammation in patients with gingivitis and mild periodontitis" Clin Exp Dent Res 7(1):78–84.
Rusdiana T, Mardhiani YD, Putriana NA, et al. (2021) "The influence of Javanese turmeric (Curcuma xanthorrhiza [sic]) on the pharmacokinetics of warfarin in rats with single and multiple-dose studies" Pharm Biol 59(1):639–46.