Ginkgo and Warfarin Interaction in a Large Veterans Administration Population

Ginkgo biloba is a widely used herbal product that could potentially have a severe interaction with warfarin, which is the most frequently prescribed anticoagulant agent in North America. Literature, however, provides conflicting evidence on the presence and severity of the interaction. In this study, we developed text processing methods to extract the ginkgo usage and combined it with prescription data on warfarin from a very large clinical data respository. Our statistical analysis suggests that taking concurrently with warfarin, gingko does significantly increase patients' risk of a bleeding adverse event (hazard ratio = 1.38, 95%CI: 1.20 to 1.58, p<.001). This study also is the first attempt of using a large medical record databaseto confirm a suspected herb-drug interaction.