title: Spontaneous bleeding associated with ginkgo biloba: a case report and systematic review of the literature: a case report and systematic review of the literature.
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.
  
  
  METHODS
  We searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database from 1966 to October 2004 with no language restrictions.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Osher Center for Integrative Medicine, University of California, San Francisco, USA. bent@itsa.ucsf.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Bent
authors.forename: Harley
authors.initials: H
authors.lastname: Goldberg
authors.forename: Amy
authors.initials: A
authors.lastname: Padula
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Avins
mesh_terms: D000368:Aged; D001760:Bleeding Time; D020441:Ginkgo biloba / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000188:drug therapy; D008517:Phytotherapy / Q000009:adverse effects*; D028321:Plant Preparations / Q000009:adverse effects*
chemical_list: D028321:Plant Preparations