BMJ Case Reports 2018; doi:10.1136/bcr-2017-223479
  • Unexpected outcome (positive or negative) including adverse drug reactions

Rare cause of isolated severe coagulation failure in cirrhosis: traditional healing with fenugreek

  1. Philip Augustine2
  1. 1The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, Kerala, India
  2. 2Department of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, Kerala, India
  1. Correspondence to Dr Cyriac A Philips, abbyphilips{at}
  • Accepted 1 January 2018
  • Published 12 January 2018


Patients with cirrhosis develop decompensation events during the natural history of the disease that encompass ascites, variceal bleeding, hepatic encephalopathy and jaundice. Coagulation failure, defined using the international normalised ratio, even though not a decompensation event, is important in patients with stratifying cirrhosis into those who require liver transplantation for long-term survival. Isolated coagulation failure in cirrhosis is rare and usually occurs with use of anticoagulants in the setting of vascular diseases. We reported the case of a patient with compensated cirrhosis in whom, isolated severe coagulation failure was found to be due to excessive use of fenugreek milk porridge as part of traditional healing. The coagulation failure was promptly reversed with avoidance of fenugreek and supplementation with vitamin K.


  • Contributors CAP: study concept and design, acquisition of data. PA: critical revision of the manuscript for important intellectual content. Both authors finalised the manuscript content.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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