Will thrombin time continue to shorten and fibrinogen levels continue to rise after quitting turmeric?

Turmeric's Effect on Thrombin Time and Fibrinogen Levels After Discontinuation

Yes, thrombin time will likely continue to shorten and fibrinogen levels will continue to rise after quitting turmeric, with values expected to return to the patient's baseline within 4-6 weeks of discontinuation. 1

Understanding the Patient's Situation

The patient used 4-8g of turmeric daily for 3 months, resulting in:

• Initial thrombin time: 18.5 seconds
• Initial fibrinogen level: 17 g/L
• After 20 days of discontinuation:
  • Thrombin time: 18.1 seconds (decreased by 0.4 seconds)
  • Fibrinogen level: 19.5 g/L (increased by 2.5 g/L)

Mechanism of Turmeric's Effect on Coagulation

Turmeric (particularly its active component curcumin) has significant anticoagulant properties:

• Inhibits platelet aggregation via thromboxane metabolism and calcium channel inhibition 1
• Inhibits generation of thrombin and factor Xa 1
• Demonstrates fibrinogenolytic activity by hydrolyzing fibrinogen subunits 2
• Prolongs activated partial thromboplastin time (aPTT) and prothrombin time (PT) 3

Expected Timeline for Normalization

Based on the available evidence:

1. Continued improvement expected: The observed trend of decreasing thrombin time and increasing fibrinogen levels will likely continue after 20 days of discontinuation.

2. Complete normalization timeline: According to perioperative guidelines, turmeric's effects on coagulation are expected to resolve within 2 weeks of discontinuation 1. However, given the prolonged use (3 months) and high dose (4-8g daily), complete normalization may take 4-6 weeks.

3. Rate of improvement: The improvement seen after 20 days (0.4 seconds decrease in thrombin time and 2.5 g/L increase in fibrinogen) suggests a gradual return to normal values.

Monitoring Recommendations

1. Repeat coagulation tests: Measure thrombin time and fibrinogen levels at 2-week intervals until normalization.

2. Thrombin time interpretation: Normal thrombin time is typically 14-16 seconds 4. The current value of 18.1 seconds is still prolonged, suggesting ongoing effect from previous turmeric use.

3. Fibrinogen level interpretation: Normal fibrinogen range is 1.5-4.0 g/L 5. The current value of 19.5 g/L appears significantly elevated, which may indicate a laboratory error or different units of measurement (possibly mg/dL instead of g/L).

Clinical Implications

• Avoid procedures with bleeding risk: Until coagulation parameters normalize, elective procedures with bleeding risk should be postponed if possible.

• Monitor for bleeding symptoms: Although improving, the patient may still have increased bleeding risk until parameters fully normalize.

• Consider vitamin K-dependent factors: Turmeric may also affect other coagulation factors, so comprehensive coagulation assessment may be warranted if bleeding symptoms persist.

Conclusion

The patient's coagulation parameters are improving after discontinuing turmeric, with thrombin time shortening and fibrinogen levels rising. This trend is expected to continue until reaching normal values, likely within 4-6 weeks of discontinuation.