Fung Foon Yin, Wong Wan Hui, Ang Seng Kok, Koh Hwee Ling, Kun Mei Ching, Lee Lai Heng, Li Xiaomei, Ng Heng Joo, Tan Chuen Wen, Zhao Yan, Linn Yeh Ching
Pharmacy, Singapore General Hospital, Outram Road, Singapore 169608.
Haematology, Singapore General Hospital, Outram Road, Singapore 169608.
Phytomedicine. 2017 Aug 15;32:88-96. doi: 10.1016/j.phymed.2017.04.004. Epub 2017 Apr 10.
Herbs with "blood-activating" properties by traditional medicine theory often raise concerns for their possible anti-platelet or anticoagulation effects based on reports from in vitro studies. Such herbs have been implicated for bleeding manifestations based on only anecdotal reports. In particular, the combination of such herbs with anti-platelet agents is often empirically advised against despite lack of good clinical evidence. Here we studied 3 commonly used herbal preparations Curcuma longa, Angelica sinensis and Panax ginseng on their respective anti-platelet and anticoagulation effect, alone and in combination with aspirin.
This is a randomized, double-blind, placebo-controlled trial involving 25 healthy volunteers for each herbal preparation.
Each subject underwent 3 phases comprising of herbal product alone, aspirin alone and aspirin with herbal product, where each phase lasted for 3 weeks with 2 weeks of washout between phases. PT/APTT, platelet function by light transmission aggregometry and thrombin generation assay by calibrated automated thrombogram were measured at baseline and after each phase. Information on adverse reaction including bleeding manifestations was collected after each phase.
On the whole there was no clinically relevant impact on platelet and coagulation function. With the exception of 5 of 24 subjects in the Curcuma longa group, 2 of 24 subjects in the Angelica sinensis group and 1 of 23 subjects in the Panax ginseng group who had an inhibition in arachidonic-acid induced platelet aggregation, there was no effect of these 3 herbals products on platelet aggregation by other agonists. Combination of these herbal products with aspirin respectively did not further aggravate platelet inhibition caused by aspirin. None of the herbs impaired PT/APTT or thrombin generation. There was no significant bleeding manifestation.
This study on healthy volunteers provides good evidence on the lack of bleeding risks of Curcuma longa, Angelica sinensis and Panax ginseng either used alone or in combination with aspirin.
根据传统医学理论，具有“活血”特性的草药常因体外研究报告引发对其可能的抗血小板或抗凝作用的担忧。基于仅有轶事性报告，此类草药被认为与出血表现有关。特别是，尽管缺乏充分的临床证据，但此类草药与抗血小板药物联合使用通常被经验性地建议避免。在此，我们研究了3种常用草药制剂姜黄、当归和人参单独及与阿司匹林联合使用时各自的抗血小板和抗凝作用。
这是一项随机、双盲、安慰剂对照试验，每种草药制剂纳入25名健康志愿者。
每位受试者经历3个阶段，分别为单独使用草药产品、单独使用阿司匹林以及阿司匹林与草药产品联合使用，每个阶段持续3周，阶段之间有2周的洗脱期。在基线及每个阶段结束后测量PT/APTT、通过光透射聚集法检测血小板功能以及通过校准自动血栓图检测凝血酶生成。在每个阶段后收集包括出血表现在内的不良反应信息。
总体而言，对血小板和凝血功能没有临床相关影响。除姜黄组24名受试者中有5名、当归组24名受试者中有2名、人参组23名受试者中有1名在花生四烯酸诱导的血小板聚集方面有抑制作用外，这3种草药产品对其他激动剂诱导的血小板聚集没有影响。这些草药产品与阿司匹林联合使用分别未进一步加重阿司匹林引起的血小板抑制。没有一种草药损害PT/APTT或凝血酶生成。没有明显的出血表现。
这项针对健康志愿者的研究提供了充分证据，表明姜黄、当归和人参单独或与阿司匹林联合使用均不存在出血风险。
