中药注射剂对华法林抗凝作用的影响及相关机制的研究进展  

Progress of the Influence of Traditional Chinese Medicine Injections on Warfarin Anticoagulation Effect and Related Mechanisms

作　　者：乔艳[1] 秦梦楠[1] 郭兴蕾 刘高峰[1] QIAO Yan;QIN Mengnan;GUO Xinglei;LIU Gaofeng(Departmentof Pharmacy, the Second Affiliated Hospital of Harbin Medical University, Key Laboratory of University in Heilongjiang Province,Harbin 150086, China;Women and Children Hospital of Qingdao City,Shandong Province, Qingdao266034, China)

机构地区：[1]哈尔滨医科大学附属第二医院药学部黑龙江省高校重点实验室,哈尔滨150086 [2]山东省青岛市妇女儿童医院,青岛266034

出　　处：《医药导报》2019年第6期765-769,共5页Herald of Medicine

基　　金：国家自然科学基金资助项目(81173659)

摘　　要：目前研究结果显示,有些中药注射剂,如丹参注射液、刺五加注射液、注射用血栓通、丹红注射液、疏血通注射液、红花注射液可使华法林的抗凝作用增强。相关作用机制包括药动学相互作用,如影响华法林的血浆蛋白结合率,抑制或诱导华法林代谢相关的细胞色素P_(450)酶,以及药效学影响。有些中药注射剂与华法林联用有出血风险,但亦有临床研究显示治疗某些血栓栓塞性疾病时,可利用两者协同抗凝作用而对治疗产生有益的影响,但尚缺乏循证研究和评价。因此,在临床用药过程中,应关注中药注射剂对华法林抗凝作用可能产生的影响,密切监测患者国际标准化比值,或适当调整华法林剂量,或避免有相互作用的药物联合应用,以保障患者用药安全。Up to now, the results showed that some traditional Chinese medicine injections such as Salvia miltiorrhiza injection, Acanthopanax injection, Xueshuantong injection, Danhong injection, Shuxuetong injection and Safflower injection could enhance the anticoagulant effect of warfarin. The mechanisms include pharmacokinetic interactions such as influence on plasma protein binding of warfarin, inhibiting or inducing activities of warfarin- related cytochrome P450 metabolic enzymes, and pharmacodynamic influence. Some traditional Chinese medicine injections have a bleeding risk in combination with warfarin. Clinical studies have also shown that the use of synergistic anticoagulant effects in the treatment of certain thromboembolic diseases can have a beneficial effect on treatment, but there is still no evidence-based research and evaluation. Therefore, attention should be paid to the possible influence of traditional Chinese medicine injections on warfarin anticoagulation in clinic, and INR needs to be monitored closely for the patients, or adjust warfarin dosage appropriately, or avoid the combined use of the two kinds of drugs with mutual effects, so as to ensure safety of patient.

关 键 词：中药注射剂 华法林 抗凝作用 

分 类 号：R969.2[医药卫生—药理学]