What happens when you take aspirin with ginkgo?
Aspirin is the most widely used antiplatelet drug in the world. Even at low doses (75 to 100 mg/day) it irreversibly acetylates the cyclooxygenase-1 (COX-1) enzyme in platelets, blocking thromboxane A2 production for the platelet's entire 7 to 10 day lifespan. The result is reduced platelet aggregation and a lower risk of arterial clots.
Ginkgo biloba leaf extract contains terpene lactones (ginkgolides A, B, and C) and flavone glycosides. Ginkgolide B is a potent inhibitor of platelet-activating factor (PAF), one of several molecules that can trigger platelets to clump together. Ginkgo also has mild antioxidant and vasodilatory effects.
Because aspirin and ginkgo affect different but parallel platelet activation pathways, taking them together produces an additive antiplatelet effect. A 2025 PLOS One analysis specifically noted that combining ginkgo biloba extract with aspirin increases minor bleeding events, though it does not appear to substantially raise the rate of major bleeds in average users.
Why is this important?
Most patients on aspirin are on it for cardiovascular reasons, and even small additive effects matter because aspirin already raises baseline bleeding risk. The most commonly reported problems are nuisance-level: bruising, longer bleeding from cuts, more frequent nosebleeds, gum bleeding when brushing. But there are also published case reports of more serious events on the combination, including subdural and intracerebral hematomas, spontaneous hyphema (bleeding into the eye), and post-surgical bleeding.
The risk is highest in older adults (whose baseline bleeding risk is already elevated), people on additional antiplatelet drugs (clopidogrel, ticagrelor), people on anticoagulants (warfarin, DOACs), people on NSAIDs or SSRIs, and patients with a history of GI ulcers or recent surgery.
Patients also commonly underestimate the impact because ginkgo is sold over the counter, often with marketing claims suggesting it improves circulation. Many do not see it as a drug, so they fail to mention it to their pharmacist or doctor.
What should you do?
If you take aspirin, even baby aspirin, the conservative default is to avoid ginkgo. The cognitive and circulatory benefits of ginkgo are modest and inconsistent in clinical trials, and the downside of an unnecessary bleed is real.
If you and your doctor decide ginkgo is worth trying, use a standardized extract (such as EGb 761) at no more than 240 mg per day, and check in periodically about whether it is delivering the benefit you hoped for. Stop ginkgo at least 7 to 10 days before any planned surgery, dental procedure, biopsy, or epidural injection.
Be alert for warning signs that warrant immediate evaluation: bruises appearing without injury, prolonged bleeding from minor cuts, persistent nosebleeds, blood in urine or stool, black tarry stools, coughing or vomiting blood, severe sudden headache, vision changes, or sudden weakness on one side.
Which specific products are affected?
This applies to aspirin in all of its forms: low-dose cardioprotective tablets (75, 81, 100, 162 mg), regular pain-relief doses (325, 500 mg), enteric-coated and chewable forms, and combination products such as Excedrin, Alka-Seltzer, and Goody's powder.
On the ginkgo side, the concern covers all standardized leaf extracts (EGb 761, GBE 24/6, Tebonin, Tanakan), as well as ginkgo teas, tinctures, and combination products in memory, brain-health, tinnitus, and circulation formulas. Ginkgo is often a hidden ingredient in proprietary nootropic blends.
The same principles apply to other antiplatelet drugs (clopidogrel, ticagrelor, prasugrel) and to anticoagulants (warfarin, DOACs).
The bottom line
Ginkgo and aspirin both reduce platelet function through complementary mechanisms, and the clinical literature shows a real increase in minor bleeds when the two are combined. Most healthy adults on low-dose aspirin will tolerate the combination, but older adults and those on additional bleeding-risk drugs should avoid ginkgo. Always disclose ginkgo use to your prescriber and pharmacist, and stop it before any planned procedure.