The patient was a healthy, retired pediatrician. He had a remote history of bleeding after using aspirin, occasional, mild hemorrhoidal bleeding, and only 1 or 2 previous nosebleeds. The patient had no excessive bleeding after previous surgical procedures. He was taking no prescription medications, but did take vitamins A, C, D, E, and folic acid for preventive care and had used ginkgo, 75 mg per day, for the previous 6 months as an aid to his “failing memory.” The ginkgo supplement, which was produced by a large U.S. manufacturer and distributed by a large supermarket chain, was standardized to 27% ginkgo flavone glycosides and 10% terpene lactones. He had never been diagnosed with cognitive dysfunction, but felt that ginkgo improved both his memory and clarity of thought.