Ginkgo leaf extract does more than prevent dementia — it may also help treat blood clots

Blood is an indispensable component of the human body. It carries oxygen absorbed by the lungs to tissues and cells throughout the body, and transports carbon dioxide back out. Nutrients and hormones the body needs are also delivered through blood vessels, which is why vascular health affects virtually every part of the body.

Among the health concerns related to blood vessels, blood clots are one of the most serious. A blood clot is a mass formed when blood solidifies inside a vessel. Clots can form as part of the normal process of sealing a damaged vessel to stop bleeding, but when the inner wall of a vessel is damaged, blood flow slows, or blood becomes prone to coagulation, clots can become a cause of vascular blockage.

What conditions do blood clots cause? Blood clots are closely linked to peripheral artery disease. In milder cases, they gradually block peripheral arteries, causing pain or inflammation in the legs and lower limbs. The condition occurs when arteries supplying blood to peripheral areas such as the legs narrow or become blocked, reducing blood flow.

Arteriosclerosis caused by hyperlipidemia is the primary cause, with high blood pressure, diabetes and smoking cited as major risk factors. The symptoms are easy to dismiss as temporary discomfort from intense exercise or fatigue, but if pain consistently develops after walking a certain distance and subsides with rest, imaging tests or arterial blood flow examinations may be needed to check for vascular problems.

The more serious concern involves the brain's blood vessels. The most representative cerebrovascular diseases caused by blood clots are cerebral infarction and cerebral hemorrhage. Cerebral infarction is an ischemic stroke that occurs when a blocked cerebral blood vessel cuts off the supply of oxygen and nutrients to brain tissue. Cerebral hemorrhage is a hemorrhagic stroke caused by a ruptured blood vessel.

When cerebral infarction occurs, neurological symptoms such as hemiplegia, speech impairment, visual disturbances and dizziness may appear. Even if symptoms arise suddenly or appear briefly and then disappear, they can be warning signs of a stroke and require immediate medical attention. These conditions are the leading cause of death among people aged 65 and older, and even minor symptoms should prompt an immediate visit to a hospital for treatment.

Leg pain that eases with rest may signal a vascular problem. The hallmark symptom that appears as clots begin to accumulate is intermittent claudication — pain in the legs during walking or exercise that subsides when the person stops. When the arteries supplying the legs narrow, muscles cannot receive as much blood as they need. Even if there is little discomfort at rest, once walking begins and muscles demand more oxygen, blood supply may fail to keep pace, triggering pain.

As the condition progresses, the walking distance before pain appears may gradually shorten. In more advanced cases, pain can occur even at rest, accompanied by a cold sensation in the legs, skin color changes and delayed wound healing. If severely reduced blood flow persists, it can lead to ulcers or tissue necrosis. Experts warn that dismissing these symptoms as simple muscle soreness or a fitness issue risks missing the critical window for clot treatment, and strongly advise visiting a specialist for a proper diagnosis.

What causes blood clots, and how are they treated? Blood clots form when vascular damage occurs due to arteriosclerosis or infection, when blood coagulates excessively, or when blood flow velocity is disrupted — factors that can act individually or in combination.

Managing and removing blood clots therefore involves administering antithrombotic agents that target these contributing factors. The mechanism works either by preventing clot formation through anticoagulants that act on clotting factors, or by dissolving existing clots through antiplatelet agents that inhibit platelet aggregation.

Antiplatelet agents suppress the process by which platelets stick together to form clots. Aspirin, clopidogrel and cilostazol are among the most commonly used, each working through a different mechanism. Aspirin inhibits the production of substances that promote platelet aggregation; clopidogrel blocks the signals that activate platelets, reducing clot formation; and cilostazol both inhibits platelet aggregation and dilates blood vessels.

Managing both clot formation and vascular condition together. In recent drug treatment for peripheral artery disease, the approach has shifted toward simultaneously suppressing clot formation with antithrombotic agents while improving blood flow through narrowed vessels. The goal is to eliminate the clots causing the disease while administering circulation-improving drugs to keep blood flowing smoothly inside vessels, preventing masses from accumulating or clumping.

Drug therapy involves administering antithrombotic agents alongside circulation-improving drugs. Cilostazol, a PDE3 inhibitor, and ginkgo biloba extract, a circulation-improving agent, have been launched as a combination product and have become the standard for combination therapy. Cilostazol inhibits PDE3 (phosphodiesterase type 3), raising levels of cAMP (cyclic adenosine monophosphate). Because cAMP plays a central role throughout the entire process of platelet activation, increasing its levels can block every pathway through which clots form.

Ginkgo biloba extract improves blood flow through three mechanisms: enhanced circulation, antioxidant action and neuroprotection. It is used to treat a wide range of conditions caused by blood flow problems — from everyday symptoms such as numbness in the hands and feet and dizziness, to improving cerebral blood flow for the prevention of cognitive impairment and dementia. By dilating blood vessels and increasing blood flow to deliver more oxygen and nutrients to the brain and peripheral tissues, it helps improve circulatory disorders such as peripheral artery disease and relieve symptoms including intermittent claudication.

The combined effect of the two drugs has been confirmed in clinical results from a combination product containing both ingredients. In a clinical trial of 105 patients with type 2 diabetes published in the international journal Diabetes & Metabolism Journal, the group receiving a combination of cilostazol 200 mg and ginkgo biloba extract 160 mg showed a significant reduction in carotid intima-media thickness after 12 months, with a statistically significant difference also observed compared with the aspirin group. Carotid intima-media thickness is an indicator of how much the vessel wall has thickened, used to assess the degree of arteriosclerosis progression.

"As arteriosclerosis progresses, the vessel wall thickens, narrowing the interior of the blood vessel and impeding smooth blood flow," said Lim Soo, a professor in the Division of Endocrinology and Metabolism at Seoul National University Bundang Hospital. "The finding that carotid intima-media thickness decreased in the group receiving the combination of cilostazol and ginkgo biloba extract suggests that combination therapy — which addresses both clot suppression and blood flow improvement together — may help slow the progression of arteriosclerotic vascular changes."