NutriStack
Apixaban and Ginkgo Biloba, a caution.
Ginkgo biloba inhibits platelet-activating factor and platelet aggregation. Case reports document spontaneous bleeding (intracranial, ocular, postoperative) with ginkgo, particularly when combined with antithrombotics. Adding ginkgo to apixaban stacks an antiplatelet effect on top of factor Xa inhibition, raising bleeding risk.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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What the row says.
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At a glance
- Substances
- Apixaban and Ginkgo Biloba
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Ginkgo biloba inhibits platelet-activating factor and platelet aggregation. Case reports document spontaneous bleeding (intracranial, ocular, postoperative) with ginkgo, particularly when combined with antithrombotics. Adding ginkgo to apixaban stacks an antiplatelet effect on top of factor Xa inhibition, raising bleeding risk.
Mechanism. Ginkgolides, particularly ginkgolide B, are potent platelet-activating factor (PAF) antagonists. They inhibit platelet aggregation and prolong bleeding time. This pharmacodynamic effect is additive to apixaban's direct factor Xa inhibition.
Recommendation. Avoid ginkgo biloba while taking apixaban. If you have been combining the two, stop the ginkgo and call your prescriber if you notice unusual bruising, nosebleeds, or any sign of bleeding.
Sources (2)
- Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with ginkgo biloba: a case report and systematic review of the literature. J Gen Intern Med. 2005;20(7):657-61. PMID 16050865
- Kellermann AJ, Kloft C. Is there a risk of bleeding associated with standardized Ginkgo biloba extract therapy? A systematic review and meta-analysis. Pharmacotherapy. 2011;31(5):490-502. PMID 21923430
Stack Score
How this pair moves the number.
Effect on the composite score
If both Apixaban and Ginkgo Biloba are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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