NutriStack
Ginkgo Biloba and Warfarin, a caution.
Ginkgo biloba has significant antiplatelet activity that increases bleeding risk when combined with warfarin. Multiple case reports document serious bleeding events including subdural hematoma, intracerebral hemorrhage, and hyphema in patients taking ginkgo with warfarin or other anticoagulants.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Ginkgo Biloba and Warfarin
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 5 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 has significant antiplatelet activity that increases bleeding risk when combined with warfarin. Multiple case reports document serious bleeding events including subdural hematoma, intracerebral hemorrhage, and hyphema in patients taking ginkgo with warfarin or other anticoagulants.
Mechanism. Ginkgolide B is a potent platelet-activating factor (PAF) antagonist that inhibits platelet aggregation. Combined with warfarin's anticoagulant effect, this creates additive risk through both coagulation cascade inhibition and impaired platelet function.
Recommendation. Avoid ginkgo biloba while taking warfarin. If already taking both, consult your prescriber about discontinuing ginkgo and monitor INR closely during any changes.
Sources (5)
- Bent S et al. The relative safety of ephedra compared with other herbal products. Ann Intern Med. 2003;138(6):468-471. PMID 12639079
- Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med. 1997;336(15):1108. PMID 9091812
- Wang M, Zeraatkar D, Obeda M, Lee M et al.. Drug-drug interactions with warfarin: A systematic review and meta-analysis. British Journal of Clinical Pharmacology. 2021. PMID 33769581
- Mousavi SN, Hosseinikia M, Yousefi Rad E, Saboori S. Beneficial effects of Ginkgo biloba leaf extract on inflammatory markers: A systematic review and meta-analysis of the clinical trials. Phytotherapy Research. 2022. PMID 35781715
- Tabrizi R, Nowrouzi-Sohrabi P, Hessami K et al.. Effects of Ginkgo biloba intake on cardiometabolic parameters in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of clinical trials. Phytotherapy Research. 2020. PMID 33090588
Stack Score
How this pair moves the number.
Effect on the composite score
If both Ginkgo Biloba and Warfarin 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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