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Spontaneous bleeding associated with Ginkgo biloba

A case report and systematic review of the literature

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Abstract

BACKGROUND: Ginkgo biloba (ginkgo) is a herbal remedy used by over 2% of the adult population in the United States. Several review articles have suggested that ginkgo may increase the risk of bleeding.

OBJECTIVE: To report a case of bleeding associated with using ginkgo, to systematically review the literature for similar case reports, and to evaluate whether using ginkgo is causally related to bleeding.

DATA SOURCES: We searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database from 1966 to October 2004 with no language restrictions.

REVIEW METHODS: Published case reports of bleeding events in persons using ginkgo were selected. Two reviewers independently abstracted a standard set of information to assess whether ginkgo caused the bleeding event.

RESULTS: Fifteen published case reports described a temporal association between using ginkgo and a bleeding event. Most cases involved serious medical conditions, including 8 episodes of intracranial bleeding. However, 13 of the case reports identified other risk factors for bleeding. Only 6 reports clearly described that ginkgo was stopped and that bleeding did not recur. Bleeding times, measured in 3 reports, were elevated when patients were taking ginkgo.

CONCLUSION: A structured assessment of published case reports suggests a possible causal association between using ginkgo and bleeding events. Given the widespread use of this herb and the serious nature of the reported events, further studies are needed. Patients using ginkgo, particularly those with known bleeding risks, should be counseled about a possible increase in bleeding risk.

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Authors and Affiliations

  1. Osher Center for Integrative Medicine, University of California, San Francisco, Calif, USA

    Stephen Bent MD, Amy Padula MS & Andrew L. Avins MD, MPH

  2. Department of Medicine, San Francisco VA Medical Center, San Francisco, Calif, USA

    Stephen Bent MD & Andrew L. Avins MD, MPH

  3. Department of Medicine, University of California, San Francisco, Calif, USA

    Stephen Bent MD & Andrew L. Avins MD, MPH

  4. Department of Family Practice, University of California, San Francisco, Calif, USA

    Harley Goldberg DO

  5. Division of Research, Kaiser Permanente Northern California, Oakland, Calif, USA

    Harley Goldberg DO & Andrew L. Avins MD, MPH

Authors
  1. Stephen Bent MD
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  2. Harley Goldberg DO
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  3. Amy Padula MS
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  4. Andrew L. Avins MD, MPH
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Corresponding author

Correspondence to Stephen Bent MD.

Additional information

None of the authors have any financial or other conflicts of interest to report regarding this study or this article.

Grant support: This work was supported by Grant Number 1 K08 ATO1338-01 (Dr. Bent) from the National Center for Complementary and Alternative Medicine (NCCAM).

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Bent, S., Goldberg, H., Padula, A. et al. Spontaneous bleeding associated with Ginkgo biloba . J GEN INTERN MED 20, 657–661 (2005). https://doi.org/10.1007/s11606-005-0114-4

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  • DOI: https://doi.org/10.1007/s11606-005-0114-4

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