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Gingko Biloba and Eliquis

Posted by tobherd 
Gingko Biloba and Eliquis
January 06, 2018 09:34PM
HI all - I haven't been on here in awhile as things have been going smoothly with my Afib, or rather, lack of it. Two ablations and all is good. However, I did end up having to be on Eliquis for reasons that don't matter to this discussion. I have a supplement that I'd like to take that has some Gingko Biloba in it, but want to be sure that's not a problem. I already have been taking some of that for well over a few years, w/o any issues - no bruising, nosebleeds, anything at all that I've noticed. I'd like to take a little more and am unsure how concerning it is, as it has a tendency to naturally thin your blood a little too. Not sure how much it really does.

Does anyone know much about this?

Thanks ~ Barb
Re: Gingko Biloba and Eliquis
January 07, 2018 09:27AM
Hi Barb - Happy New Year. Glad to see all is going well for you. Are you taking the full dose of Eliquis? Also,
how much ginkgo is in the supplement you're taking?

Jackie
Re: Gingko Biloba and Eliquis
January 07, 2018 03:07PM
HI Jackie - thank you. Happy New Year to you too!

I am taking 5 mgs twice/day, so yes, I think that is the full dose....

The supplement has a total of 60 mg. of Proteases (Bromelain, Aspergillus, Oryzae var), Quercetin powder, Bilberry extract and Ginkgo Biloba (leaf) extract,.all together. The Gingko is the last item mentioned, so I believe it is the least. I have already been taking this for the past few years with out any issues. I would like to take double the amount....I have to assume that the Ginkgo itself is no more than 20 mgs., as the 60 mgs. is divided up by the 4 different categories (Proteases, Quercetin, Bilberry and Gingko).

Barb
Re: Gingko Biloba and Eliquis
January 07, 2018 04:20PM
Barb - yes, that's the full dose. Now, this is very important:

If you haven't read my recent post on the nosebleed experience on half-dose of Eliquis... please, definitely read as a reminder for you that you are on a full dose of a very potent blood thinner and you don't want to take anything that would add to that potency. So, I while absolutely love ginkgo biloba and used it daily for many years prior to Eliquis at a dose of 80 mg, I would not consider even half that amount of ginkgo while using any size dose of Eliquis.

Also, the proteases, bromelain,quercetin and bilberry all have blood thinning properties and it's typically mentioned not to use those if on a blood thinner.

While my nosebleed was dramatic in that the volume of blood was so abundant, I did manage to get it under control in a relatively short period of time and I wasn't at all 'panicked' but it definitely was a significant reminder that if a nose capillary rupture could produce that much blood so quickly, I'd hate to see a severe wound from a cut or fall. The other significant factor was that I was at home and actually right outside the bathroom so the sink was only 8 feet away. I immediately thought how fortunate the timing was rather than had I been driving or shopping for food. That would have been quite a mess and inconvenience.

Please be safe, Barb, and stop using that supplement unless your EP or cardiologist says otherwise.

Jackie
Re: Gingko Biloba and Eliquis
January 07, 2018 05:12PM
HI Jackie - thanks for the information. I won't take any additional gingko then, per your advice. I am going to continue as I have been doing for now, and try to get an appt to see Dr. Natale when he is in the NY area again, for a follow up. I don't know if I would do a Watchman, but the thought is there, as i don't like taking something that has so many precautions...and there are so many health benefits to using things like gingko and other heart healthy supplements. They are having a big symposium on all of this stuff later this week, I believe, so perhaps there will be even more recent info to help make any decisions.

Keep in mind - and please don't take this personally - but age probably does play a factor in how easily someone bleeds, don't you think? Doing things that might aggravate the situation would likely be more of a concern as we get older...just as medication often needs to be reduced as people get older. At least that's what I've read...

All good advice. Thank yousmiling smiley Barb
Re: Gingko Biloba and Eliquis
January 07, 2018 05:45PM
Hi Barb - Yes, that's undoubtedly true that the elderly have more risk of bleeding as mentioned in cautions about GI and brain bleeds when using these anticoagulants that don't have reversal agents.

However, I did do a quick search on the topic and found this quote:

"When we look at patients who are older than 80 or younger than 80 where we had a demarcation for dose reduction, we see that there really is no difference by age category. There is no clear difference in treatment effect based on age," he said. Patients who had two or more of the criteria were eligible for the reduced dose of the anticoagulant. "
[www.medpagetoday.com]

Please be cautious and be well,
Jackie
Joe
Re: Gingko Biloba and Eliquis
January 07, 2018 08:08PM
Chronological age or biological age?
Re: Gingko Biloba and Eliquis
January 08, 2018 04:28PM
Jackie - Does that apply to their skin being thinner? I would think people with thinner skin (more common as we age) would therefore be more likely to bleed..no? And bruise....

Glad you brought up the reversal agent...is there one yet for Eliquis?

Shannon and I were talking about the Watchman..what are your thoughts on that? Going for another procedure sounds daunting, but having a blood thinner that brings so many concerns is too.

I will be careful...I tend to be a cautious person overall. Thank you for your counsel and advicesmiling smiley ~ Barb
Re: Gingko Biloba and Eliquis
January 08, 2018 08:24PM
Yes there are reversal agents for the new DOAC (direct oral anticoagulation) drugs like Eliquis and Xarelto, but they are VERY new and likely not in stock at every ER department nationwide, nor could you count on emergency physicians being trained on their proper use. Sadly I think we are still a few years away from that not being the case and in the meantime caution is still the word of the day when it comes to DOAC use. At the very least, get a medical bracelet that indicates which anticoagulant you are taking in the event of an emergency.
Re: Gingko Biloba and Eliquis
January 08, 2018 08:37PM
External bleeds aren't what you need to worry about with anticoagulants. Even nosebleeds, which can be dramatic as Jackie described, aren't life threatening. I spent 15 years in EMS and have seen dozens and dozens of severe nose bleeds. I've seen houses that looked like murder scenes due to nosebleeds, especially with people on warfarin and home oxygen (oxygen dries your nasal passages). But not a single one of those nose bleeds warranted priority transport (ie, lights and sirens). The amount of blood loss it takes to become dangerous is far more substantial than most people believe. Trust me, it's a lot more than most people have ever seen and far more than Hollywood would have you believe.

The danger of bleeding with anticoagulants is primarily 1) in the brain and 2) elsewhere internally, usually the GI tract. Bleeding in the brain is a hemorrhagic stroke and it can be every bit as devastating as an embolic stroke (from a clot). In fact, they're often more devastating than embolic strokes. Bleeding elsewhere isn't as dangerous, but can still be life-threatening. You can lose a lot of blood into your GI tract before it even becomes apparent you're bleeding, so that's the danger there. However, bleeding to death is very unlikely as long as you can get medical help promptly.

The third danger, of course, is major trauma -- car accidents, falls, etc. If you manage to lop off a foot with the lawnmower, that's a grievous injury even without anticoagulants, but it becomes more of a concern with them. The bleeding will be more difficult to control, but controlling external bleeding isn't as difficult as people think. If EMS can get to you promptly, they will control external bleeding no matter how severe. I promise you that. And once they get you to a surgeon s/he will stop that bleeding. External bleeding is usually easy to control and not likely to kill you unless it's truly massive. It's the internal bleeding you can't see and surgeons can't get to that's dangerous. And once again, head injury is the big danger here. Avoid falls. Falls in the home cause an astonishing number of serious injuries and deaths every year.


No, there's no reversal agent for Eliquis yet, but my understanding is it's in the FDA approval process and expected to be available soon.
Re: Gingko Biloba and Eliquis
January 08, 2018 08:39PM
Quote
wolfpack
Yes there are reversal agents for the new DOAC (direct oral anticoagulation) drugs like Eliquis and Xarelto

You sure about that? I thought the Eliquis reversal agent got sent back for further testing last year and hasn't been approved in the US yet.
Re: Gingko Biloba and Eliquis
January 09, 2018 02:35PM
Barb - Thinner skin for some people is certainly a factor but the main focus of my 'nosebleed' post was just a reminder to those on Eliquis or similar and thinking ahead about what to do if one crops up was my focus. I was home but if away from home, it would have been really messy.

As I commented initially, because some of us live where the climate has turned very frigid, that can certainly dry out nasal membranes as can low household humidity. That was the FYI factor "awareness" tip.

Since you are younger, the consideration for the Watchman is an important one. Yes, it's another procedure but my view is, it's definitely worth doing so you are free from not only the bleeding risk factor if you fall or have a severe accident, but getting the chemical out of your body. Who knows what other long-term side effects might develop?

Check out this info from People's Pharmacy alert on unexpected side effects:
[www.peoplespharmacy.com]

Be well,
Jackie
Re: Gingko Biloba and Eliquis
January 09, 2018 10:50PM
Quote
Carey

You sure about that? I thought the Eliquis reversal agent got sent back for further testing last year and hasn't been approved in the US yet.

I recall reading an article about the reversal agent for Pradaxa and that it was effective against all the factor Xa anticoagulants. The veracity of the article I can’t speak to. My take on it is that these things are in their nacency and it will be some time before they become as well understood as Vitamin K to reverse Warfarin.
Re: Gingko Biloba and Eliquis
January 13, 2018 11:07PM
Carey - are you saying that you have seen many cases of Eliquis causing a brain bleed, and therefore a stroke? I would hate to think that the agent that is recommended for avoiding a clot is even more dangerous for potentially causing a stroke in a different way....it sounds like a no-win situation.

Jackie - is the Watchman what Shannon had when he had an issue? I am thinking about it, but with these devices being fairly new, one has to wonder if they are completely safe as well. Ahhh...damn genetics!

~ Barb
Re: Gingko Biloba and Eliquis
January 14, 2018 07:02PM
Quote
tobherd
Carey - are you saying that you have seen many cases of Eliquis causing a brain bleed, and therefore a stroke? I would hate to think that the agent that is recommended for avoiding a clot is even more dangerous for potentially causing a stroke in a different way....it sounds like a no-win situation.

No, I didn't say that at all.
Re: Gingko Biloba and Eliquis
January 15, 2018 06:17PM
Carey - can you please clarify what you were saying when you wrote about Eliquis and the brain. It's unclear what your message was.

Thank you ~ Barb
Re: Gingko Biloba and Eliquis
January 15, 2018 09:35PM
Quote
tobherd
Carey - can you please clarify what you were saying when you wrote about Eliquis and the brain. It's unclear what your message was.

Sorry, I'll try to clarify. I wrote mainly about nose bleeds and such, so please don't mix my comments about that with comments about brain bleeds. Very different things. What I wrote is quoted below with the parts about brain bleeding in bold:

Quote

The danger of bleeding with anticoagulants is primarily 1) in the brain and 2) elsewhere internally, usually the GI tract. Bleeding in the brain is a hemorrhagic stroke and it can be every bit as devastating as an embolic stroke (from a clot). In fact, they're often more devastating than embolic strokes. Bleeding elsewhere isn't as dangerous, but can still be life-threatening. You can lose a lot of blood into your GI tract before it even becomes apparent you're bleeding, so that's the danger there. However, bleeding to death is very unlikely as long as you can get medical help promptly.

All I was saying there is that bleeding in the brain is an especially serious place for a bleed to happen. For example, if a small bleed develops in your intestine, that blood simply mingles with the food you eat and might not even be noticed until you have a medical exam and they detect occult blood in your stool. You might not experience any symptoms at all if the bleed is small enough. But that same amount of blood bleeding in your brain could be catastrophic.

So what's the difference? There are two reasons:

1) Your brain is exquisitely sensitive to lack of blood flow and lack of oxygen. Lack of blood flow to brain tissue results in tissue damage in minutes, and the damage is irreparable if it continues very long at all. Most other organs in your body can withstand lack of blood flow for much longer (hours in the case of non-cardiac muscles, for example). If the lack of blood flow is total, irreparable death of the brain tissue affected will occur in about 5-8 minutes. Whatever that part of the brain did before will be gone. It might be your memories, your ability to speak, your ability to use your left arm, or your ability to swallow. It could be anything and just depends on the part of the brain affected. That's what a stroke is, and whether the lack of blood flow is caused by a clot or by a bleed doesn't matter much. The end result is the same.

2) Unlike your intestines and most other organs in your body, blood in the brain has nowhere to go. Your skull is a closed container and if you're bleeding into it, that creates pressure inside your skull, and the blood also causes irritation and swelling which just adds to the pressure. That increasing pressure can reduce blood flow to the rest of your brain by squeezing arteries off, or even squeezing parts of your brain out the openings in your skull if the pressure becomes high enough. That pressure can be deadly, and largely explains why hemorrhagic strokes tend to be more devastating than embolic strokes.

And finally, you need to keep in mind that all the bad stuff above also happens to people who don't take anticoagulants, don't have afib, and don't fall and hit their head. It just happens sometimes. All we can do is hope we're not one of those unlucky few.

So now that I've filled you with dread about hemorrhagic strokes, what does all this have to do with Eliquis? Frankly, not that much. All the anticoagulants come with a slightly increased risk of bleeding in the brain and elsewhere. Eliquis happens to be on the low end of the scale in that regard, actually. It has about the safest track record with regard to bleeding out of all the anticoagulants.

When you and your doctor decide that you need an anticoagulant, it's a measured judgement of risks. Which risk is greater for you in your current situation? Bleeding from an anticoagulant or stroke from lack of one? For example, right now my biggest risk is clots, not bleeds, so I'm taking Eliquis daily and probably will be for some time. But for the previous two years I wasn't taking any anticoagulant at all because the equation was different and my risk of bleeds was greater than my risk of clots.

I've probably just muddied the waters more for you than clarified, but the takeaway message you get from this is that the threat of blood clots from lack of anticoagulants is probably greater for you than the threat of bleeds from taking them, so you should stick with the Eliquis.
Re: Gingko Biloba and Eliquis
January 16, 2018 11:12PM
Thank you for clarifying that. I have had two ablations, both with Dr. Natale, and have been Afib free now since the second one, in June 2014. As it was a LAA isolation ablation, your numbers all have to be good to not have to be on a blood thinner. One of my numbers was e on the border..so they had me on the lowest dose of Eliquis. Fast forward to March 2016, and I got walking pneumonia. Was sent for a Cat scan of my abdomen, as I was feeling very nauseas for awhile. They saw a small "wedge shaped" spot in my kidney, and after much discussion and head scratching, decided it was likely a small blood clot. I told them I had a severe muscle pull the year before in that same area..but since they didn't see a shadow, so determined it was probably more recent..... (I still believe that's what it was from, but...). My cardiologist decided that the low dose of Eliquis was not enough, and ramped it up to 5mgs. twice/day instead. I was not..and am not..happy about that.

I'm hoping to get an appt. with Dr. Natale when he is up here in the NY area, to get his opinion and also possibly discuss getting the Watchman..although the thought does scare me. However, I don't like the idea of worrying about a possible brain bleed..aka stroke...and I don't want to worry about any possible drug or vitamin interactions....

I am glad to hear that Eliquis is one of the safer ones...that's a good thing.

Have a good night ~ Barb
Re: Gingko Biloba and Eliquis
January 17, 2018 12:14AM
Get that appointment with Natale, go with his advice, and don't worry so much about the Eliquis and drugs and vitamins. You'll be fine. grinning smiley
Re: Gingko Biloba and Eliquis
January 18, 2018 09:17PM
Good advice. Thanks. And yes, I can be a worrier....lol

Be well ~ Barb
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