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Bromelain is a natural proteolytic
enzyme derived from the stems of pineapples.1 Introduced as a
therapeutic compound in 1957, bromelain’s purported uses include
treatment of arthritis, burns, cancer prevention, cancer treatment, edema,
indigestion and vascular disorders.2,4 Bromelain has numerous
actions in the body. However, the most important actions for patients on
warfarin (Coumadin, Jantoven) therapy to be aware of are its antiplatelet and fibrinolytic
effects. In a study published in 1972, researchers demonstrated a decrease
in platelet aggregation in patients receiving bromelain therapy. The
significance of the decrease in platelet aggregation is difficult to
evaluate with only 20 subjects included in the study. However, the
investigators did demonstrate that bromelain has antiplatelet effects.
This decrease in the amount of active platelets is similar to the actions
of aspirin on platelets. In addition to antiplatelet effects, bromelain
also has fibrinolytic activity.4 This means that bromelain
increases the conversion of plasminogen to plasmin. Plasmin acts to
degrade fibrin (clot material) into smaller pieces that can be removed by
the immune system.2 This is similar to what happens when a scab
is removed. This activity in addition to its antiplatelet effects makes
bromelain unsafe for use in patients on warfarin (Coumadin, Jantoven) therapy. Bromelain has
the potential to increase prothrombin time (PT/INR). Although the
significance of the interaction between bromelain and warfarin (Coumadin,
Jantoven) is unknown,
patients on chronic warfarin (Coumadin, Jantoven) therapy need to be aware that taking both
products could cause an increased risk of bleeding.
References:
- Hale LP, Greer PK, Sempowski GD. Bromelain Treatment Alters
Leukocyte Expression of Cell Surface Molecules Involved in Cellular
Adhesion and Activation. Clinical Immunology.
2002;104(2):183-90.
- Kelly GS. Bromelain: A Literature Review and Discussion of its
Therapeutic Applications. Alt Med Review. 1996;1:243-257.
- Heinicke RM, VanderWal M, Yokoyama MM. Effect of Bromelain on Human
Platelet Aggregation. Experientia. 1972;28:844-45.
Memorial Sloan-Kettering Cancer Center. Bromelain. 2002. Available at: http://www.mskcc.org/mskcc/html/11571.cfm?RecordID=540.
Accessed: February 25, 2003.
© 2003 Shawna Lucero (used by permission)
An editorial about the
lack of concern for manufacturers of these products and their interactions
with other medications.
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