title: Coltsfoot as a potential cause of deep vein thrombosis and pulmonary embolism in a patient also consuming kava and blue vervain.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Freshour
authors.forename: Brian
authors.initials: B
authors.lastname: Odle
authors.forename: Somi
authors.initials: S
authors.lastname: Rikhye
authors.forename: David W
authors.initials: DW
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D006801:Humans; D020901:Kava; D008297:Male; D008517:Phytotherapy / Q000009:adverse effects*; D010936:Plant Extracts / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology*; D031207:Tussilago / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology*; D032412:Verbena
chemical_list: D000925:Anticoagulants; D010936:Plant Extracts