Tsai Hsin-Hui, Lin Hsiang-Wen, Tsai Chiu-Lin, Yam Felix K, Lin Sheng-Shing
Department of Cosmetic Science, Providence University, 200, Sec. 7, Taiwan Boulevard, Taichung 43301, Taiwan.
Department of Nursing, National Taichung University of Science and Technology, 193, Sec. 1, Sanmin Road, Taichung 40343, Taiwan.
Evid Based Complement Alternat Med. 2017;2017:9417186. doi: 10.1155/2017/9417186. Epub 2017 Aug 2.
Despite the evidence that some commonly used Chinese medications (CMs) have antiplatelet/anticoagulant effects, many patients still used antiplatelets combined with CMs. We conducted a nested case-crossover study to examine the associations between the concomitant use of antiplatelets and CMs and major bleeding using population-based health database in Taiwan. Among the cohort of 79,463 outpatients prescribed antiplatelets (e.g., aspirin and clopidogrel) continuously, 1,209 patients hospitalized with new occurring bleeding in 2012 and 2013 were included. Those recruited patients served as their own controls to compare different times of exposure to prespecified CMs (e.g., Asian ginseng and dong quai) and antiplatelet agents. The periods of case, control 1, and control 2 were defined as 1-4 weeks, 6-9 weeks, and 13-16 weeks before hospitalization, respectively. Conditional logistic regression analyses found that concurrent use of antiplatelet drugs with any of the prespecified CMs in the case period might not significantly increase the risks of bleeding over that in the control periods (OR = 1.00, 95% CI 0.51 to 1.95 and OR = 1.13, 95% CI 0.65 to 1.97). The study showed no strong relationships between hospitalization for major bleeding events and concurrent use of antiplatelet drugs with the prespecified CMs.
尽管有证据表明一些常用的中药具有抗血小板/抗凝作用，但许多患者仍将抗血小板药物与中药联合使用。我们进行了一项巢式病例交叉研究，以利用台湾基于人群的健康数据库，研究抗血小板药物与中药联合使用与大出血之间的关联。在连续开具抗血小板药物（如阿司匹林和氯吡格雷）的79463名门诊患者队列中，纳入了2012年和2013年因新发出血而住院的1209名患者。这些入选患者作为自身对照，以比较不同时间接触预先指定的中药（如人参和当归）和抗血小板药物的情况。病例期、对照1期和对照2期分别定义为住院前1 - 4周、6 - 9周和13 - 16周。条件逻辑回归分析发现，在病例期，抗血小板药物与任何一种预先指定的中药同时使用，出血风险可能不会比对照期显著增加（比值比 = 1.00，95%可信区间0.51至1.95；比值比 = 1.13，95%可信区间0.65至1.97）。该研究表明，大出血事件住院与抗血小板药物和预先指定的中药同时使用之间没有密切关系。
