Theoretically, ginkgo may increase bleeding risk when used together with warfarin; however, two randomised double-blind studies have found that Ginkgo biloba does not affect the pharmacokinetics, pharmacodynamics, INR or clinical effects of warfarin (Engelson et al 2003, Jiang et al 2003), and two clinical trials have not found evidence of significant effects on bleeding (Bal Dit et al 2003, Kohler et al 2004). Due to the potential seriousness of such an interaction, caution is still advised.

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