Key result
Ginkgo biloba plus aspirin is associated with enhanced platelet inhibition versus aspirin alone in AIS.
Why the study?
Although Ginkgo biloba extract is effective for acute ischemic stroke, concerns regarding bleeding events have been raised, prompting investigation into its mechanisms of efficacy and impact on platelet activity and coagulation.
Does Ginkgo biloba extract combined with aspirin improve platelet aggregation inhibition and affect bleeding risk in patients with acute ischemic stroke?
Observational (n=99)
No
Does Ginkgo biloba extract combined with aspirin improve platelet aggregation inhibition and affect bleeding risk in patients with acute ischemic stroke?
Ginkgo biloba extract enhances the antiplatelet effect of aspirin in acute ischemic stroke but may increase the risk of minor bleeding.
May increase minor bleeding risk with low-dose aspirin in acute ischemic stroke; leaves open need for randomized safety trials.
BACKGROUND AND PURPOSE: Although Ginkgo biloba extract (GBE) has been shown to be effective in treating acute ischemic stroke (AIS) in several clinical trials, concerns regarding adverse events, such as bleeding, have been raised. This study aimed to investigate the mechanisms by which GBE improves AIS prognosis, particularly its impact on platelet activity, coagulation function, and the potential risk of bleeding. METHODS: This real-world study consecutively enrolled 99 patients: 49 with internal jugular venous stenosis (IJVS) treated with GBE; 33 with AIS treated with GBE and low-dose aspirin; and 17 with AIS treated with low-dose aspirin alone. Plasma platelet aggregation and coagulation status were assessed before and after treatment. Major and minor bleeding events were recorded in the AIS group. RESULTS: In the IJVS group, GBE specifically inhibited arachidonic acid (AA)-induced, but not ADP-induced, platelet aggregation, along with prolonged thrombin time (PT) and activated partial thromboplastin time (APTT). In the AIS group, the combined use of low-dose aspirin and GBE further reduced AA-induced platelet aggregation, mildly prolonged APTT, and was associated with an increased risk of minor bleeding events. CONCLUSIONS: The therapeutic effect of GBE in AIS may, in part, be attributed to its ability to enhance the antiplatelet action of aspirin, particularly in inhibiting AA-induced platelet aggregation. However, the potential for increased bleeding risk warrants further investigation.
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Huang et al. (2025) conducted an observational in Acute ischemic stroke and internal jugular venous stenosis (n=99). Ginkgo biloba extract and low-dose aspirin vs. Low-dose aspirin alone was evaluated on Inhibition of arachidonic acid (AA)-induced platelet aggregation (p=0.020). The combination of Ginkgo biloba extract and low-dose aspirin significantly enhanced the inhibition of arachidonic acid-induced platelet aggregation compared to aspirin alone in patients with acute ischemic stroke.
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