Drug General Information (ID: DDIX3U6ZLM)
Drug Name			Ginkgo biloba		Drug Info		Antithrombin III human		Drug Info
Drug Type		Natural product				Protein/peptide
Therapeutic Class		Herbal Products				Recombinant Antithrombin

Mechanism of Ginkgo biloba-Antithrombin III human Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Ginkgo biloba				Antithrombin III human
Mechanism		Risk of bleeding Antiplatelet effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Ginkgo biloba and Antithrombin III human

Recommended Action
Management		Patients should consult a healthcare provider before taking any herbal or alternative medicine. In general, consumption of ginkgo should be avoided during use of coagulation-modifying agents and at least two weeks prior to surgery. In patients who have used this herb extensively prior to receiving anticoagulation, antiplatelet or thrombolytic therapy, the potential for an interaction should be considered. Close clinical and laboratory observation for hematologic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1	Benjamin J, Muir T, Briggs K, Pentland B "A case of cerebral haemorrhage - can Ginkgo biloba be implicated?." Postgrad Med J 77 (2001): 112-3. [PMID: 11161079]
2	Evans V "Herbs and the brain: friend or foe? The effects of ginkgo and garlic on warfarin use." J Neurosci Nurs 32 (2000): 229-32. [PMID: 10994537]
3	Jayasekera N, Moghal A, Kashif F, Karalliedde L "Herbal medicines and postoperative haemorrhage." Anaesthesia 60 (2005): 725-6. [PMID: 15960738]