Bent Stephen, Goldberg Harley, Padula Amy, Avins Andrew L
Osher Center for Integrative Medicine, University of California, San Francisco, USA.
J Gen Intern Med. 2005 Jul;20(7):657-61. doi: 10.1111/j.1525-1497.2005.0121.x.
Ginkgo biloba (ginkgo) is a herbal remedy used by over 2% of the adult population in the United States. Several review articles have suggested that ginkgo may increase the risk of bleeding.
To report a case of bleeding associated with using ginkgo, to systematically review the literature for similar case reports, and to evaluate whether using ginkgo is causally related to bleeding.
We searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database from 1966 to October 2004 with no language restrictions.
Published case reports of bleeding events in persons using ginkgo were selected. Two reviewers independently abstracted a standard set of information to assess whether ginkgo caused the bleeding event.
Fifteen published case reports described a temporal association between using ginkgo and a bleeding event. Most cases involved serious medical conditions, including 8 episodes of intracranial bleeding. However, 13 of the case reports identified other risk factors for bleeding. Only 6 reports clearly described that ginkgo was stopped and that bleeding did not recur. Bleeding times, measured in 3 reports, were elevated when patients were taking ginkgo.
A structured assessment of published case reports suggests a possible causal association between using ginkgo and bleeding events. Given the widespread use of this herb and the serious nature of the reported events, further studies are needed. Patients using ginkgo, particularly those with known bleeding risks, should be counseled about a possible increase in bleeding risk.
银杏是一种草药疗法，在美国超过2%的成年人使用。几篇综述文章表明银杏可能会增加出血风险。
报告一例与使用银杏有关的出血病例，系统回顾文献中类似的病例报告，并评估使用银杏与出血是否存在因果关系。
我们检索了1966年至2004年10月的MEDLINE、EMBASE、IBIDS和Cochrane协作数据库，无语言限制。
选择已发表的使用银杏的人发生出血事件的病例报告。两名评审员独立提取一组标准信息，以评估银杏是否导致出血事件。
15篇已发表的病例报告描述了使用银杏与出血事件之间的时间关联。大多数病例涉及严重的医疗状况，包括8例颅内出血。然而，13篇病例报告确定了其他出血危险因素。只有6篇报告明确描述停用银杏后出血未复发。3篇报告中测量的出血时间在患者服用银杏时有所延长。
对已发表病例报告的结构化评估表明，使用银杏与出血事件之间可能存在因果关联。鉴于这种草药的广泛使用以及所报告事件的严重性，需要进一步研究。应告知使用银杏的患者，尤其是那些已知有出血风险的患者，其出血风险可能会增加。
