Yu Zongliang, Li Xiaoya, Zhang Xiaonan, Li Dan, Gu Yimeng, Wu Min, Liu Longtao
Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Evid Based Complement Alternat Med. 2021 Oct 27;2021:9956248. doi: 10.1155/2021/9956248. eCollection 2021.
Ischemic heart disease is a significant risk factor that threatens human health, and antiplatelet drugs are routinely used to treat cases in clinical settings. Chinese medicine for promoting blood circulation and removing blood stasis (PBCRBSCM) can often be combined with antiplatelet drugs to treat ischemic heart disease. PBCRBSCM can inhibit platelet adhesion, activation, and aggregation; moreover, PBCRBSCM in combination with antiplatelet drugs exerts antiplatelet effects. The mechanism is related to several factors, including the inhibition of platelet activation and aggregation, improvement of the hemodynamic status and coagulation function, and correction of metabolism and inflammation. PBCRBSCM can also regulate the absorption and metabolism of conventional antiplatelet drugs and protect the gastric mucosal epithelial cells against damage induced by conventional antiplatelet drugs. Randomized controlled trials have confirmed that PBCRBSCM preparations and the active ingredients in these preparations can reduce resistance to aspirin and clopidogrel so that the combination of these drugs can exert their antiplatelet effects. In the perioperative treatment of patients with stable angina pectoris, unstable angina pectoris, and acute coronary syndrome undergoing percutaneous coronary intervention therapy, preparations of the active ingredients of PBCRBSCM combined with antiplatelet drugs and other conventional Western medicine treatments have been proven effective. The efficacy and safety of such combinations have also been extensively verified. Considerable progress has been made to understand the antiplatelet mechanism of PBCRBSCM. However, most clinical studies had problems, such as limited sample size and inappropriate research design, which has limited the translational use of PBCRBSCM in antiplatelet therapy. A large-scale, multicenter, randomized controlled study with cardiovascular events as the endpoint is still to be conducted to provide evidence for the combined application of PBCRBSCM and antiplatelet drugs in the prevention and treatment of ischemic heart disease.
缺血性心脏病是威胁人类健康的重要危险因素，抗血小板药物在临床中常用于治疗此类病症。活血化瘀类中药常与抗血小板药物联合用于治疗缺血性心脏病。活血化瘀类中药可抑制血小板黏附、激活和聚集；此外，活血化瘀类中药与抗血小板药物联合使用可发挥抗血小板作用。其机制与多种因素有关，包括抑制血小板激活和聚集、改善血流动力学状态和凝血功能以及纠正代谢和炎症。活血化瘀类中药还可调节传统抗血小板药物的吸收和代谢，并保护胃黏膜上皮细胞免受传统抗血小板药物所致的损伤。随机对照试验已证实，活血化瘀类中药制剂及其制剂中的活性成分可降低对阿司匹林和氯吡格雷的抵抗，从而使这些药物联合使用时能发挥抗血小板作用。在接受经皮冠状动脉介入治疗的稳定型心绞痛、不稳定型心绞痛和急性冠状动脉综合征患者的围手术期治疗中，活血化瘀类中药活性成分制剂与抗血小板药物及其他传统西药联合治疗已被证明有效。此类联合用药的有效性和安全性也已得到广泛验证。在了解活血化瘀类中药的抗血小板机制方面已取得了相当大的进展。然而，大多数临床研究存在样本量有限和研究设计不当等问题，这限制了活血化瘀类中药在抗血小板治疗中的转化应用。仍需开展一项以心血管事件为终点的大规模、多中心、随机对照研究，为活血化瘀类中药与抗血小板药物联合应用于缺血性心脏病的防治提供依据。
