活血化瘀中药增强华法林抗凝作用及机制的研究进展

doi:10.19803/j.1672-8629.20220169

摘要/Abstract

摘要： 华法林是临床常用双香豆素类抗凝剂,广泛用于心脑血管疾病的辅助治疗,预防和治疗血栓栓塞性疾病。但其治疗窗窄,个体差异大,且华法林与多种药物和食物存在相互作用,易致出血或抗凝不足的风险。活血化瘀中药在心血管疾病治疗方面应用广泛,临床与华法林联用情况较多,有些活血化瘀中药与华法林联用存在增加出血的风险。本文通过查阅文献发现活血化瘀中药增强华法林抗凝作用的机制,主要包括药动学方面的相互作用及药效学方面的影响。建议临床同时应用活血化瘀中药和华法林时,密切监测患者国际标准化比值,适当调整华法林剂量,避免存在相加作用的中药合用,为患者安全、合理用药提供保障。

关键词: 活血化瘀, 中药, 华法林, 抗凝作用, 细胞色素P450酶, 国际标准化比值

Abstract: Warfarin is a double coumarin anticoagulant commonly used in clinic. It is widely used in the adjuvant treatment of cardiovascular and cerebrovascular diseases and in the prevention and treatment of thromboembolic diseases. However, its treatment window is narrow, individual differences are huge, and warfarin interacts with a variety of drugs and foods, which is likely to lead to the risk of bleeding or insufficient anticoagulation. Traditional Chinese medicines for promoting blood circulation and removing blood stasis are widely used in the treatment of cardiovascular diseases, and there are many cases where warfarin is used in combination with TCM. Such combination, however, can increase the risk of bleeding. By consulting the literature, this paper found that the mechanism by which traditional Chinese medicines for promoting blood circulation and removing blood stasis can enhance the anticoagulant effect of warfarin mainly involves the interactions of pharmacokinetics and pharmacodynamic effects. It is recommended that when traditional Chinese medicines for activating blood circulation and removing blood stasis and warfarin are used together in clinical practice, the international standardized ratio of patients should be closely monitored, and the dosage of warfarin should be appropriately adjusted in order to prevent the combination of traditional Chinese medicines with additive effects and ensure safe and rational use of drugs.

Key words: promoting blood circulation and removing blood stasis, traditional Chinese medicine, warfarin, anticoagulation, cytochrome P450 enzyme, INR

中图分类号:

R972

刘甜甜, 曹俊岭, 张彦丽, 巩颖, 顾媛媛. 活血化瘀中药增强华法林抗凝作用及机制的研究进展[J]. 中国药物警戒, 2023, 20(1): 117-120.

LIU Tiantian, CAO Junling, ZHANG Yanli, GONG Ying, GU Yuanyuan. Research progress in enhancing anticoagulant effects of warfarin and the mechanism by traditional Chinese medicine for promoting blood circulation and removing blood stasis[J]. Chinese Journal of Pharmacovigilance, 2023, 20(1): 117-120.

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