Talasaz Azita H, McGonagle Bridget, HajiQasemi Mohsen, Ghelichkhan Zahra A, Sadeghipour Parham, Rashedi Sina, Cuker Adam, Lech Tara, Goldhaber Samuel Z, Jennings Douglas L, Piazza Gregory, Bikdeli Behnood
Department of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, New York, New York.
Department of Pharmacy, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
Semin Thromb Hemost. 2025 Jun;51(5):560-571. doi: 10.1055/s-0044-1790258. Epub 2024 Sep 17.
Interactions between food and oral anticoagulants (OACs), particularly vitamin K antagonists such as warfarin, are widely recognized and may also be clinically relevant for direct OACs. Pharmacokinetic and pharmacodynamic interactions with food or herbs can lead to anticoagulation potentiation, increased risk of bleeding, or reduced drug efficacy, all compromising patient safety. We conducted a systematic search for randomized controlled trials (RCTs) on PubMed for assessments of interactions between OACs and various ingestants. Since the RCT evidence was slim, we also reviewed prospective longitudinal studies, case series, and case reports to identify possible associations between foods and anticoagulation therapy. We referred to basic or translational studies that shared putative explanations for such interactions, but we failed to identify high-quality evidence in most cases. The limited evidence, small sample size of the studies, conflicting results, and possible heterogeneity in the contents of herbal products prevent a conclusive assessment of these interactions. Existing evidence suggests that (1) cranberry juice consumption (up to 240 mL/d and probably even more) with warfarin is safe; (2) use of green leafy vegetables with a high daily content (more than 250 µg) of vitamin K should be cautioned for patients receiving warfarin, because it may decrease warfarin efficacy. It is also advisable for patients to maintain highly constant intake of green leafy vegetables to ensure stable warfarin effectiveness; (3) ginger, even in small quantities (excluding commercial ginger-flavored beverages, which contain only negligible amounts of ginger), and mango (more than one fruit) can both potentiate warfarin effects; (4) patients taking OACs should avoid St. John's wort due to diminished anticoagulant effect; and (5) consumption of less than 240 mL of grapefruit juice daily is unlikely to interact with OACs. Future longitudinal observational cohort studies and RCTs with larger sample sizes are needed to study specific interactions between food or herbal products and OACs.
食物与口服抗凝剂（OACs）之间的相互作用，尤其是与华法林等维生素K拮抗剂之间的相互作用，已得到广泛认可，并且对于直接作用的OACs可能也具有临床相关性。与食物或草药的药代动力学和药效学相互作用可导致抗凝作用增强、出血风险增加或药物疗效降低，所有这些都会危及患者安全。我们在PubMed上系统检索了关于OACs与各种摄入物之间相互作用评估的随机对照试验（RCT）。由于RCT证据稀少，我们还回顾了前瞻性纵向研究、病例系列和病例报告，以确定食物与抗凝治疗之间可能的关联。我们参考了对这类相互作用有假定解释的基础或转化研究，但在大多数情况下未能找到高质量证据。证据有限、研究样本量小、结果相互矛盾以及草药产品成分可能存在的异质性，使得无法对这些相互作用进行确定性评估。现有证据表明：（1）服用华法林时饮用蔓越莓汁（每日最多240毫升，甚至可能更多）是安全的；（2）接受华法林治疗的患者应慎用每日维生素K含量高（超过250微克）的绿叶蔬菜，因为这可能会降低华法林疗效。患者保持绿叶蔬菜摄入量高度恒定以确保华法林疗效稳定也是可取的；（3）生姜，即使少量（不包括仅含微量生姜的商业生姜味饮料），以及芒果（一个以上水果）都可增强华法林的作用；（4）服用OACs的患者应避免使用圣约翰草，因为其抗凝作用会减弱；（5）每日饮用少于240毫升葡萄柚汁不太可能与OACs发生相互作用。未来需要进行更大样本量的纵向观察队列研究和RCT，以研究食物或草药产品与OACs之间的特定相互作用。
