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A year-old white male presented with leg pain and swelling, tachycardia, and pleuritic chest pain.

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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 daggakava-kava, St. John's Wort, blue vervain, and Dreamer's Blend® comprised of Calea zacatechichi, vervain, Entada rheedii, wild lettuce, and Eschscholzia californica.

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A hypercoagulable work-up was negative. The patient was treated with enoxaparin and warfarin and was discharged home.

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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.

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Kava and vervain have estrogenic properties. Of the medications consumed by this self-proclaimed "herbalist," coltsfoot is a potential cause of venous thromboembolic disease VTE. President Arnold Rüütli ja haridus- ja teadusminister Toivo Maimetsa ettekannetest üleriigilisel konverentsil "

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