title: Risk of hemorrhage associated with co-prescriptions for Ginkgo biloba and antiplatelet or anticoagulant drugs.
abstract: OBJECTIVE
  The aim of this study was to explore the risk of hemorrhage associated with co-prescriptions for Ginkgo biloba extract (GBE) and antiplatelet or anticoagulant agents, and evaluate the trends of co-prescriptions.
  
  
  METHODS
  A retrospective population based study was performed by using claim data of the Taiwan National Health Insurance Research Database from 2000 to 2008. Prescriptions for GBE alone and in combination with antiplatelet/anticoagulant drugs were retrieved and the odds ratio for co-prescriptions after the first prescription of GBE was explored.
  
  
  RESULTS
  The total number of prescriptions for GBE alone or in combination with antiplatelet or anticoagulant agents increased gradually from 1547 (0.08%) and 3575 (0.19%) in 2000 to 4676 (0.23%) and 15,297 (0.79%) in 2008, respectively. GBE was mostly prescribed to patients aged 60 years or older. The adjusted odds ratio for co-prescriptions associated with the risk of hemorrhage is 1.5 (95% confidence interval, 0.5-5.0). The risk of hemorrhage was associated with patients aged ≥65 and male patients, who were prescribed GBE alone (adjusted odds ratio: 3.8 and 1.4; 95% confidence interval, 2.8-5.2 and 1.1-1.9).
  
  
  CONCLUSIONS
  Although the combination of G. biloba extract with antiplatelet or anticoagulants showed insignificant correlation to the risk of hemorrhage, patients using ginkgo, particularly those with known bleeding risks and elderly, should take a particular attention to the possibility of increasing risk of bleeding.
authors.affiliation: Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Agnes L F
authors.initials: AL
authors.lastname: Chan
authors.forename: Henry W C
authors.initials: HW
authors.lastname: Leung
authors.forename: Jia-Wen
authors.initials: JW
authors.lastname: Wu
authors.forename: Tsair-Wei
authors.initials: TW
authors.lastname: Chien
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000639:trends; D020441:Ginkgo biloba; D006470:Hemorrhage / Q000139:chemically induced*; D041743:Herb-Drug Interactions; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D016017:Odds Ratio; D008517:Phytotherapy / Q000009:adverse effects*; D010936:Plant Extracts; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D012737:Sex Factors; D013624:Taiwan; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010936:Plant Extracts; D010975:Platelet Aggregation Inhibitors