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Side Effects Bleeding: most common and serious risk (nosebleeds, gum bleeding, bruising, gastrointestinal bleeding) Skin necrosis: rare, usually early in therapy Purple toe syndrome: rare complication Teratogenic: dangerous in pregnancy (especially first trimester) Interactions Drugs: Many antibiotics, antifungals, and NSAIDs can increase bleeding risk or alter INR

ALC was generally well tolerated, with predominantly mild gastrointestinal or central nervous system adverse events and no excess of serious harms compared with controls

10.1038/nature09325 23 HuZ.ZhangH.YiB.YangS.LiuJ.HuJ.et al (2020)