O3‐04–03: A 240‐mg once‐daily formulation of Ginkgo Biloba extract EGb 761^® is effective in both Alzheimer's disease and vascular dementia: Results from a randomized controlled trial

Is There a Risk of Bleeding Associated with Standardized Ginkgo bilobaExtract Therapy? A Systematic Review and Meta‐analysis

“…Subgroup analyses. Forest plots of meta-analysis for Ginkgo biloba extract daily dose and population status for the outcome parameters activated partial thromboplastin time (aPTT) and prothrombin time (PT), based on the selected studies: Ihl 2008, 28 Kanowski 1996, 31 Koehler 2004, 36 Kim 2005, 35 Kudolo 2004, 24 Kudolo 2006, 23 Napryeyenko 2007, 29 and Schneider 2005. 30 For the meta-analysis, a very broad systematic search strategy was chosen to ensure not to miss a publication relevant to the research question.…”

“…For four of the included studies, unpublished data were made available by the sponsor [28][29][30][31] ; for one of these studies, no published report was available at the time of analysis. 28…”

“…Four studies were identified as being of low quality with Jadad scores less than 3 32,34,38,42 ; eight studies achieved the highest Jadad quality rating 24,28,29,31,33,35,39,41 Assessment of risk of bias using the Cochrane tool yielded only one study with a low bias risk. 33 A high risk of bias was found for seven studies (including the studies with low Jadad score), 23,30,32,34,37,38,42 and an unclear risk of bias was judged to be present in 10 studies.…”

“…33 A high risk of bias was found for seven studies (including the studies with low Jadad score), 23,30,32,34,37,38,42 and an unclear risk of bias was judged to be present in 10 studies. 24,28,29,31,35,36,[39][40][41]43 In the sensitivity analysis, inclusion of studies with high bias risk showed no impact on calculated effects. On the basis of these results, all identified studies remained in the meta-analysis for detailed examination.…”

“…Heterogeneity among studies was reduced for the outcomes blood flow, aPTT, and ADPinduced platelet aggregation when studies with a high bias risk were excluded, and was reduced for aPTT when studies using a GBE preparation other than EGb 761 were excluded. Both sensitivity analyses on aPTT led to the exclusion of the same three studies 23,24,35 and impacted on the results in the same manner for the remaining 34 Galduroz 2007, 32 Ihl 200, 28 Kanowski 1996, 31 Koehler 2004, 36 Kim 2005, 35 Koza 1991, 42 Kudolo 2004, 24 Kudolo 2006, 23 Mehlsen 2002, 39 Muir 2002, 40 Napryeyenko 2007, 29 Santos 2003, 37 Schneider 2005, 30 Sollier 2003, 38 and Wang 2007. 33 four studies: GIV −0.47 second, 95% CI −0.90 to −0.05 second, I 2 =3%.…”