Table 1.

Published Case Reports of Bleeding Associated with Ginkgo biloba (ginkgo)

Reference	Age/Gender	Daily Dose (mg)	Duration	Clinical Risk Factor for Bleeding	Clinical Presentation	Bleeding Event	Clinical Course	Dechallenge* Yes/No/NR, Time	Bleeding Time/Rechallenge
Rowin and Lewis16	33, F	120	2 y	None	3 mo of headache, 2 wk of diplopia, nausea, vomiting	Bilateral subdural hematomas	Surgical evacuation and full recovery while taking Ginkgo	Yes, 15 mo	Yes†
Rosenblatt and Mindell17	70, M	80	1 wk	Aspirin 325 mg/d	2 d of blurred vision	Spontaneous hyphema	Bleeding stoppped spontaneously in 5 min	Yes, 3 mo	No
Vale18	61, M	120 to 160	6+ mo	None	5 d of headache, back pain, nausea, sleepiness	Subarachnoidhemorrage	Full recovery	Yes, 4 mo	Yes‡
Matthews19	78, F	NR	2 mo	Hypertension, warfarin for 5 y	2 d of inability to feed herself and apraxia	Left parietal hemorrage	Some apraxia remained in 1 mo	No	No
Fessenden et al.20	34, M	NR	NR	None	Excessive bleeding after laproscopic cholecystectomy	375 mL of bloody fluid from surgical drain in abdomen	Hemoglobin fell 16.5 to 5.4 g/dL, transfused 2 units	NR	No
Benjamin et al.21	56, M	120	18 mo	None	Acute confusion, unable to stand, severe pain behind eye	Right parietal hematoma	Permanent left inferior quadrantanopia	NR	No
Miller and Freeman22	78, M	150	6 mo	Fall 5 d prior to admission	Headache, confusion, right-sided weakness after a fall	Left subdural hematoma	Patient underwent surgical evacuation and uneventful postoperative course	NR	No
Hauser et al.15	59, M	NR	NR	Cirrhosis	Peri-hepatic fluid collections after liver transplant	Multiple peri-hepatic hematomas	Patient underwent surgical evacuation of hematomas and was discharged	No	No
Hauser et al.15	59, M	NR	NR	Cirrhosis, 81 mg aspirin	Blurred vision	Vitreous hemorhage		Yes, time not specified	No
Schneideret al.23	65, M	600	8 wk	None	6 wk of blurred vision	Spontaneous hyphema	Complete resolution	Yes, 18 mo	No
Purroy Garcia et al.24	75, M	80	1 mo	NR	Nausea, vomiting	Cerebellar hematoma	NR	NR	No
Gilbert25	72, F	150	6 to 7 mo	NR	6 mo of memory impairment and dizziness	Subdural hematoma	NR	NR	No
Fong and Kinnear26	65, F	120	2 y	None	Sudden eye pain, proptosis, bruising, reduced vision during injection of anesthetic in inferotemporal region of orbit for cataract surgery	Acute retrobulbar hemorrhange	Surgical decompression with return of baseline vision	NR	No
Meisel et al.27	71, M	80	2½ y	Ibuprofen	Coma	Intracerebral mass bleeding	Death	NA	No
Bent (2005)	73, M	75	6 to 7 mo	Vitamin E	Spontaneous bleeding from ear and nose, ecchymosis on hands and arm	Ecchymosis, epistaxis		Yes, 4 y	Yes§

^*Dechallenge indicates whether the drug was withdrawn, and the length of follow-up after drug cessation.

^†Bleeding times were 15.0 and 9.5 minutes when taking ginkgo and 6.5 and 6.5 minutes after 35 days washout; normal range not reported.

^‡Bleeding time on ginkgo was 6 minutes; 4 months after discontinuation of ginkgo bleeding time was 3 minutes (normal range 1–3 minutes).

^§Bleeding time off of ginkgo was 5.5 minutes (normal range 2.5 to 9.5 minutes). Ginkgo restarted for 10 weeks, and patient had only occasional ecchymoses. Repeat bleeding time on ginkgo was greater than 15 minutes.

M, male; F, female; NR, not reported; NA, not applicable.