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Spontaneous bleeding associated with Ginkgo biloba

A case report and systematic review of the literature

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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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  1. Richman A, Witkowski JP. 7th Annual herb sales survey. Whole Foods Magazine. 2001: 23–30.

  2. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002;287:337–44.

    Article  PubMed  Google Scholar 

  3. Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, Pa: Hanley & Belfus Inc.; 2002.

    Google Scholar 

  4. Ernst E, Pittler MH. Ginkgo biloba extract for dementia: a systematic review of double-blind, placebo-controlled trials. Clin Drug Invest. 1999;17:301–8.

    Article  Google Scholar 

  5. Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol. 1998;55:1409–15.

    Article  PubMed  CAS  Google Scholar 

  6. Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John’s Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med. 2002;136:42–53.

    PubMed  Google Scholar 

  7. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001;286:208–16.

    Article  PubMed  CAS  Google Scholar 

  8. Foster S, Tyler V. Tyler’s Honest Herbal. Binghamton, NY: The Haworth Press; 1999.

    Google Scholar 

  9. Fugh-Berman A. The 5-Minute Herb & Dietary Supplement Consult. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.

    Google Scholar 

  10. Kudolo GB, Dorsey S, Blodgett J. Effect of the ingestion of Ginkgo biloba extract on platelet aggregation and urinary prostanoid excretion in healthy and type 2 diabetic subjects. Thromb Res. 2002;108:151–60.

    Article  PubMed  CAS  Google Scholar 

  11. Chung KF, Dent G, McCusker M, Guinot P, Page CP, Barnes PJ. Effect of a ginkgolide mixture (BN 52063) in antagonising skin and platelet responses to platelet activating factor in man. Lancet. 1987;1:248–51.

    Article  PubMed  CAS  Google Scholar 

  12. Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil. 2000;81:668–78.

    PubMed  CAS  Google Scholar 

  13. Birks J, Grimley Evans J, Van Dongen M. Ginkgo biloba for cognitive impairment and dementia. In: The Cochrane Library. Issue 3 ed. Oxford, UK: Update Software; 2003.

    Google Scholar 

  14. Jones JK. Determining causation from case reports. In: Strom BL, ed. Pharmacoepidemiology. 3rd ed. New York, NY: John Wiley & Sons Ltd; 2000:525–538.

    Google Scholar 

  15. Hauser D, Gayowski T, Singh N. Bleeding complications precipitated by unrecognized Ginkgo biloba use after liver transplantation. Transpl Int. 2002;15:377–9.

    Article  PubMed  Google Scholar 

  16. Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion. Neurology. 1996;46:1775–6.

    PubMed  CAS  Google Scholar 

  17. Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med. 1997;336.

  18. Vale S. Subarachnoid haemorrhage associated with Ginkgo biloba. Lancet. 1998;352.

  19. Matthews MK Jr. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology. 1998;50:1933–4.

    PubMed  Google Scholar 

  20. Fessenden JM, Wittenborn W, Clarke L. Ginkgo biloba: a case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy. Am Surg. 2001;67:33–5.

    PubMed  CAS  Google Scholar 

  21. Benjamin J, Muir T, Briggs K, Pentland B. A case of cerebral haemorhage—can Ginkgo biloba be implicated? Postgrad Med J. 2001;77:112–3.

    Article  PubMed  CAS  Google Scholar 

  22. Miller LG, Freeman B. Possible subdural hematoma associated with Ginkgo biloba. J Herb Pharmacother. 2002;2:57–63.

    Article  PubMed  Google Scholar 

  23. Schneider C, Bord C, Misse P, Arnaud B, Schmitt-Bernard CF. Spontaneous hyphema caused by Ginkgo biloba extract. J Fr Ophtalmol. 2002;25:731–2.

    PubMed  CAS  Google Scholar 

  24. Purroy Garcia F, Molina C, Alvarez Sabin J. Spontaneous cerebellar haemorrhage associated with Ginkgo biloba ingestion. Med Clin (Barcelona). 2002;119:596–7.

    Google Scholar 

  25. Gilbert GJ. Ginkgo biloba. Neurology. 1997;48.

  26. Fong KC, Kinnear PE. Retrobulbar haemorrhage associated with chronic Ginkgo biloba ingestion. Postgrad Med J. 2003;79:531–2.

    Article  PubMed  CAS  Google Scholar 

  27. Meisel C, Johne A, Roots I. Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis. 2003;167.

  28. Engelsen J, Nielsen JD, Winther K. Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients: a randomised, double blind, placebo-crossover trial. Thromb Haemostasis. 2002;87:1075–6.

    CAS  Google Scholar 

  29. Kohler S, Funk P, Kieser M. Influence of a 7-day treatment with Ginkgo biloba special extract EGb 761 on bleeding time and coagulation: a randomized, placebo-controlled, double-blind study in healthy volunteers. Blood Coagul Fibrin. 2004;15:303–9.

    Article  Google Scholar 

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Correspondence to Stephen Bent MD.

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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).

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