EBO2 (EBOO), Blood Thinners, and Other Medicines: What the Sources Say and What to Ask

No study has tested EBO2 (also called EBOO) in people who take blood thinners, and no source we found sets out which medicines interact with it. What the sources do give is narrower: how the circuits are kept from clotting, what the label of heparin, the anticoagulant the EBOO papers describe, warns about, what one researcher reported with blood pressure medicines, and what clinics say on their own pages. This guide collects those, then lists the questions they leave for the doctor who prescribes your medicines, and everything the sources do not cover.

Ozone therapy is not FDA-approved for any condition; federal regulation calls ozone “a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy” [29]. Nothing here is a reason to start, stop, or change a medicine.

How the circuit is kept from clotting

Blood drawn into a bag or circuit is mixed with an anticoagulant so it does not clot there, as clinics describe it [16][17]. The papers in our library report the anticoagulant this way:

The pattern is heparin in the continuous circuits and in 10-pass ozone, and citrate in most single-bag autohemotherapy. The Siena group’s first paper on the method preferred citrate in sheep [32], while its later description of human treatment calls the blood heparinized [1]. Only the ozone dialysis paper says how much of the heparin solution reaches the patient [2], and none of the texts we read reports checking clotting times during a session.

The volumes differ widely. The Siena review describes treating up to 4,800 mL of heparinized blood in an hour [1]; the 2025 New York case report gives about 2 liters per treatment under that clinic’s protocol [10]; a Texas clinic says about 2 liters of blood are filtered in its one-hour session [25]; and the ozone dialysis paper ran its pump at 30 to 40 mL per minute for an hour [2]. The autohemotherapy papers above treated 100 to 225 mL of blood at a time [5][6][7][8]. The table under “From our data” shows the blood volume each EBOO paper reports.

Clinics describe the same choice. A South Carolina clinic says it uses a heparin protocol during EBOO to prevent clots in the circuit [16]. A Miami Beach clinic calls heparin a short-acting blood thinner used during EBOO, and its description of a glass-jar ozone procedure adds that its heparin comes from a porcine source [17].

What heparin’s label warns about

FDA-approved prescribing information for one heparin product, Hospira’s heparin sodium in sodium chloride injection, sets out these points [12]. They describe heparin in general; the label does not mention EBO2.

• Strengths. Heparin is supplied in several strengths. The label reports fatal hemorrhages from medication errors and says to confirm the correct strength before giving it.
• Who should not receive it. People with a history of heparin-induced thrombocytopenia (HIT), a serious immune reaction to heparin; people with a known hypersensitivity to heparin or pork products (the label also notes that the drug is derived from porcine intestinal mucosa); people with uncontrollable active bleeding; and, for full-dose heparin, people whose blood clotting cannot be tested at suitable intervals.
• Bleeding. Hemorrhage, including fatal events, has occurred, and can happen at almost any site. The label lists conditions with higher bleeding risk, among them severe high blood pressure, hemophilia, low platelet counts, stomach or intestinal ulcers, liver disease with impaired clotting, and the period during and right after a spinal tap or major surgery. It reports more bleeding in women over 60.
• HIT. HIT can cause clots in veins and arteries, and can appear up to several weeks after heparin is stopped. The label calls for monitoring the platelet count in everyone who receives heparin.
• Other drugs. Drugs that interfere with clotting or platelet function may induce bleeding. The label names aspirin, ibuprofen, indomethacin, dipyridamole, hydroxychloroquine, dextran, and phenylbutazone among platelet inhibitors to use with caution. Heparin can also prolong the prothrombin time used to manage warfarin, and some drugs, including digitalis, tetracyclines, antihistamines, and intravenous nitroglycerin, may partly counteract it.
• Potassium. The label advises measuring potassium before heparin in people at risk of high potassium.

How much heparin a given EBO2 session gives a patient is not published, so these warnings cannot be scaled to the procedure. That is a question for the clinic, and the answer is one to share with the prescribing doctor.

Who the studies included

A finding about harms applies only to the kinds of people studied. The 2022 autohemotherapy trial that reported no complications excluded people with severe disorders including hematologic disorders and coagulation dysfunction, people allergic to anticoagulants such as sodium citrate, and pregnant or breastfeeding women, and it checked coagulation in everyone it admitted [5]. The ozone dialysis measurements came from consecutive patients at the authors’ clinic with no exclusion criteria, but the paper reports no bleeding outcomes [2]. A 2026 case series excluded patients with contraindications to the treatment without listing them [7]. The EBOO abstracts we read do not say whether anyone taking a blood thinner was included [1][11].

Other medicines the sources mention

• ACE inhibitors. Bocci’s book chapter reports a sudden, marked fall in blood pressure when ozonated blood was reinfused quickly into patients taking ACE inhibitors, an unpublished observation by other clinicians that he says he confirmed in two patients, during autohemotherapy [13]. He lists treatment with ACE inhibitors among the situations that preclude or limit ozone therapy [13]. No EBOO paper addresses it.
• Citrate. In the same chapter, tingling of the lips and tongue near the end of reinfusion is attributed to excess citrate returned too quickly, a temporary drop in calcium [13].
• Heparin with other ozone treatment. An evidence map of ozone therapy for COVID-19 lists nosebleeds associated with concomitant heparin use among the few adverse events in the studies it reviewed [14].
• High-dose vitamin C. A 2022 letter is titled as a report of new methemoglobinemia after ozone autohemotherapy given with a high-dose vitamin C injection; we could read only its title [15].
• Vitamin K. A Dallas clinic lists high-dose vitamin K use among reasons a person is not eligible for EBO2, without giving a reason [27].

What clinics say about blood thinners and heparin

Heparin is prescription-only in New South Wales, where the Health Care Complaints Commission found that a non-registered practitioner at an ozone clinic had obtained heparin “from an unknown source” and “is not authorised to be in possession of, or to administer” it [31].

These are examples from pages we saved on September 28, 2026, not a count. As of September 28, 2026, 127 of the 163 clinics whose EBO2 page we could read have an intake statement in our published dataset, the one quoted statement per clinic about what happens before a first session; 8 of those 127 mention medications, and none names blood thinners. A clinic’s intake page can be short and its screening thorough, so the questions below are worth asking either way. The clinic directory lists what each clinic states.

Questions for the doctor who prescribes your medicines

• The clinic says its circuit uses heparin (or citrate). With the blood thinner I take, what would that add to my bleeding risk?
• Is there anything in my history, such as a reaction to heparin, low platelets, or an allergy to pork products, that the clinic needs to know?
• Which of my medicines and supplements affect bleeding, clotting, or platelets?
• Would any of my medicines need to change around a procedure like this, and who would manage that?
• Do I need blood tests first, such as a platelet count?
• I take an ACE inhibitor. Is the report of low blood pressure with fast reinfusion of ozonated blood relevant to me?

Questions for the clinic

• Which anticoagulant does the circuit use, how much, and how is it given: as a single dose, a drip, or added to the line?
• Who prescribes the heparin, who gives it, and which product and strength is used?
• Who sets the dose, and does it change for someone who takes a blood thinner?
• Is clotting or the platelet count checked before or during the session?
• What happens if a needle site keeps bleeding after the session, and how do I reach the clinic after hours?
• Will the clinic speak with my prescribing doctor?

Our doctor questions tool builds a printable list of questions from our guides, including the contraindications guide. A bleeding problem or reaction after any ozone procedure can be reported to FDA through MedWatch [30]; our adverse events guide explains how.

What we could not verify

• Any study of EBO2 in people on anticoagulants. We found none, for warfarin, the newer oral anticoagulants such as apixaban or rivaroxaban, clopidogrel, or aspirin.
• Results for the people trials left out. The trial that reported no complications excluded people with coagulation dysfunction [5], so its result says nothing about them, and the EBOO abstracts do not state their exclusions.
• Heparin doses in EBO2 practice. No EBOO paper we read states the amount, and clinic pages do not publish theirs.
• Clotting checks during sessions. None of the papers reports them.
• Whether the circuit’s heparin raises bleeding at the IV sites afterward. The ozone dialysis paper states how much heparin solution reaches the patient but reports no bleeding outcomes [2].
• The 10-pass heparin total. The paper does not say whether the flask’s 7,500 units are replaced for each pass [3], so we give no total.
• Supplements. No source we found addresses fish oil, vitamin E, ginkgo, or other supplements with EBO2.
• The vitamin K rule and the ACE inhibitor report. The first has no stated reason; the second rests on an unpublished observation and two patients during a different procedure.
• Clinics’ claims about compatibility with most medicines. We found no study behind them.

How this guide was made

We used 32 sources: fourteen papers from our research library and NCBI, a book chapter, an FDA-approved heparin label from DailyMed, a federal regulation, an Australian commission’s order, FDA’s MedWatch form, and thirteen clinic pages saved on September 28, 2026, labeled clinic-stated. The intake count comes from our clinic dataset as of September 28, 2026, and the two tables under “From our data” are computed from it and from our study cards when the site is built. Drafting used AI tools. A human editor has not yet checked this guide claim by claim against its sources, and no clinical reviewer has signed off yet.