MajorDirect oral anticoagulants (factor Xa inhibitors)×Herbal agents for cognitive disorders
Updated · Methodology
Mechanism
Apixaban inhibits factor Xa while ginkgo acts on platelet function: bleeding risk adds up at two separate levels of haemostasis. The European monograph places anticoagulants among the treatments that require consultation before taking ginkgo. Unlike warfarin, there is no INR to warn you here: apixaban is not routinely monitored, so the first warning may be the bleed itself.
Symptoms
Gastrointestinal bleeding (black stools, coffee-ground vomit), haematuria, extensive bruising, nosebleeds that do not stop with pressure. Any of these needs urgent attention.
Management
Do not start this combination on your own. Anyone already taking ginkgo with apixaban should raise it at the next appointment; withdrawing the supplement is the first option considered, because the anticoagulant has an indication and ginkgo rarely has one of the same strength. Before surgery or dental extraction, stop ginkgo two weeks ahead.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- EMA: European Union herbal monograph on Ginkgo biloba L., folium (2015)– EMA/HMPC, final EU herbal monograph, Ginkgo biloba L., folium