Zhuang Wei, Liu Shaoli, Zhao Xusheng, Sun Nan, He Tao, Wang Yali, Jia Beibei, Lin Xiaolan, Chu Yanqi, Xi Shengyan
Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, China.
Department of Pharmacy, Haiyang People's Hospital, Haiyang, China.
Front Pharmacol. 2021 Sep 20;12:751107. doi: 10.3389/fphar.2021.751107. eCollection 2021.
Warfarin is a commonly used oral anticoagulant. It has a narrow therapeutic window and wide variation in individualized dosing, and is used clinically for the treatment of thromboembolic diseases. Due to the widespread use of traditional Chinese medicine (TCM) in China and the complex composition and diverse mechanisms of action of TCM, the combination of TCM and warfarin in patients has led to fluctuations in the international normalized ratio of warfarin or bleeding. To ensure rational clinical use, we summarize the TCMs with which warfarin interacts and the possible mechanisms, with a view to providing a clinical reference. To summarize the mechanisms by which Chinese herbal medicines affect the enhancement or weakening of the anticoagulant effect of warfarin, to provide theoretical references for clinicians and pharmacists to use warfarin safely and rationally, and to avoid the adverse effects associated with the combination of Chinese herbal medicines and warfarin. A computerized literature search of electronic databases, including PubMed, MEDLINE, Cochrane Library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI) and WANFANG Data was performed. Key words used in the literature search were "warfarin", "Chinese medicine", "traditional Chinese medicine", "Chinese patent medicine" etc. and their combinations in a time limit from January 1, 1990 to May 1, 2021. A total of 64 articles were obtained following the selection process, including clinical reports, pharmacological experiments and experiments which were reviewed to determine the mechanism of the anticoagulant effect of herbal medicine on warfarin. The mechanisms affecting the anticoagulant effect of warfarin are complex, and herbal medicines may enhance and diminish the anticoagulant effect of warfarin through a variety of mechanisms; thus, clinical use needs to be cautious. Some herbal medicines have shown inconsistent results in both and experiments, pharmacology and clinical studies, and should be the focus of future research. With the widespread use of TCM, the combination of warfarin and TCM is more common. This article will promote clinicians' knowledge and understanding of the TCMs which interact with warfarin, in order to avoid the occurrence of adverse clinical treatment processes, and improve the efficacy and safety.
华法林是一种常用的口服抗凝剂。它的治疗窗较窄，个体给药差异较大，临床上用于治疗血栓栓塞性疾病。由于中药在中国广泛应用，且中药成分复杂、作用机制多样，患者同时使用中药和华法林会导致华法林的国际标准化比值波动或出血。为确保临床合理用药，我们总结了与华法林相互作用的中药及其可能机制，以期提供临床参考。总结中药影响华法林抗凝作用增强或减弱的机制，为临床医生和药师安全合理使用华法林提供理论参考，避免中药与华法林联用带来的不良反应。对电子数据库进行计算机化文献检索，包括PubMed、MEDLINE、Cochrane图书馆、科学网（WOS）、中国知网（CNKI）和万方数据。文献检索使用的关键词为“华法林”“中药”“传统中药”“中成药”等及其组合，时间范围为1990年1月1日至2021年5月1日。经过筛选过程共获得64篇文章，包括临床报告、药理实验以及审查以确定草药对华法林抗凝作用机制的实验。影响华法林抗凝作用的机制复杂，草药可能通过多种机制增强或减弱华法林的抗凝作用；因此，临床使用需谨慎。一些草药在药理和临床研究实验中结果不一致，应是未来研究的重点。随着中药的广泛应用，华法林与中药的联用更为常见。本文将增进临床医生对与华法林相互作用的中药的认识和理解，以避免不良临床治疗过程的发生，提高疗效和安全性。
