Table 4.

Approximation of overall bleeding risk for each supplement, based on the highest level of evidence for each

Bleeding risk*	Supplement
High (4)	Garlic; hawthorn; ginkgo biloba; chondroitin-glucosamine
Moderate (25)	Cordyceps sinensis; echinacea; aloe vera Melatonin; turmeric; bilberry; chamomile; fenugreek; milk thistle; peppermint; cinnamon Flaxseed; grape seed extract Ashwagandha; black pepper; dandelion; evening primrose; feverfew; honey; lavender; lion’s mane St. John’s wort; ginger; cranberry; spirulina
Low (15)	Acidophilus; apple cider vinegar; beet; elderberry; goldenseal; horny goat weed; tea tree oil; valerian Black cohosh; chlorella vulgaris; green tea; menthol; propolis; red yeast rice; isoflavones
None (3)	Fish oil; ginseng; saw palmetto

^*Inclusion in the “high risk” group is supported by high-level evidence in the clinical setting: systematic reviews, cohort studies, randomized controlled trials, and large case series. Supplements in the “moderate risk” group are supported by case reports (a, b), platelet aggregation studies (c), basic science research (d), or unclear/conflicting evidence (e). Supplements in the “low risk” group have no reported bleeding risk in the literature (a) or procoagulant properties (b). Supplements in the “no risk” group have strong evidence that suggests no clinical association with bleeding. The data include both surgical bleeding and anticoagulant-related bleeding risk.