基于病例报告文献对草药和膳食补充剂降低华法林抗凝作用的分析与评价  

Analysis and evaluation on decrease of anticoagulant effect of warfarin by herbal and dietary supplements based on case report literature

作　　者：王丽君 陈冰[2] 张鹏[2] 江宇泳[3] 蔡晧东[3] Wang Lijun;Chen Bing;Zhang Peng;Jiang Yuyong;Cai Haodong(Department of Pharmacy,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Pharmacy,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Center of Integrated Traditional and Western Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京地坛医院药学部,北京100015 [2]首都医科大学宣武医院药学部,北京100053 [3]首都医科大学附属北京地坛医院中西医结合中心,北京100015

出　　处：《药物不良反应杂志》2023年第9期556-563,共8页Adverse Drug Reactions Journal

摘　　要：目的对病例报告报道的草药和膳食补充剂(HDS)的降低华法林抗凝作用进行分析和评价。方法检索国内外相关数据库(截至2023年6月24日),选择草药、HDS与华法林相互作用致抗凝作用降低的病例报告,根据患者国际标准化比值降低程度和血栓事件发生情况评价HDS与华法林相互作用程度;根据HDS与华法林相互作用的因果关系、病例报告数量和其他证据(国家相关机构发布警告、临床研究、药代动力学/药效动力学研究、动物实验研究等),建立HDS与华法林相互作用可靠性评分标准。≥9分为高度可靠,6~8分为较可靠,3~5分为可能可靠,≤2分为可疑可靠。结果共收集到17篇文献,涉及25例患者、11种HDS。降低华法林抗凝作用程度为重度的HDS有2种,包括人参(西洋参,红参等)和没药;中度者5种,包括贯叶连翘、茶(绿茶、红茶)、薄荷、辅酶Q_(10)和壳聚糖;轻度者4种,包括黄芪、牛油果、海藻和黄豆。降低华法林抗凝作用可靠性评价结果为高度可靠者仅1种,为贯叶连翘(评分为10分);较可靠者2种,为人参和茶(评分分别为8和6分);可能可靠者7种,包括没药、薄荷、辅酶Q_(10)、壳聚糖、黄芪、牛油果和海藻(评分分别为5、5、5、4、4、4和3分);可疑者1种,为黄豆(评分为2分)。结论贯叶连翘、人参(西洋参,红参等)和茶(绿茶、红茶)等HDS降低华法林抗凝作用的程度和可靠性均较高,应引起临床医师和临床药师的高度重视。Objective To analyze and evaluate the decrease of anticoagulant effect of warfarin by herbal and dietary supplements(HDS)based on case report literature.Methods The case reports on decrease of anticoagulant effect of warfarin by HDS were selected by searching the relevant databases at home and abroad(up to June 24,2023).The degree of decrease of anticoagulant effect of warfarin by HDS was evaluated according to the reduction degree of international normalized ratio and the occurrence of thrombotic events in patients in the case reports.The reliability scoring criteria of HDS-warfarin interaction was established according to the causality of the interaction between HDS and warfarin,the number of case reports,and the other evidences(warnings issued by relevant national institutions,clinical studies,pharmacokinetic/pharmacodynamic studies,animal studies,etc.).It was evaluated as highly,relatively,possibly,and suspiciously reliable if the total score was≥9,6-8,3-5,and≤2 points,respectively.Results A total of 17 case reports were enrolled in the analysis,involving 25 patients and 11 kinds of HDS.Two kinds of HDS reduced the anticoagulant effect of warfarin severely,including ginseng(Radix Ginseng)[(American ginseng(Radix Panacis Quinquefolii),red ginseng,etc.]and Myrrh;5 kinds of HDS reduced the anticoagulant effect of warfarin moderately,including St.John′s wort(Hypericum perforatum L.),tea[green tea(Camellia sinensis),black tea],peppermint(Herba Menthae),coenzyme Q_(10),and chitosan;4 kinds of HDS reduced the anticoagulant effect of warfarin slightly,including milkvetch root(Radix Astragali seu Hedysari),avocado,seaweed(Sargassum),and soya(Glycine max).The reliability of anticoagulant effect reduction of warfarin was evaluated as highly reliable in 1 kind of HDS,namely St.John′s wort(10 points),relatively reliable in 2 kinds of HDS,including ginseng and tea(8 and 6 points,respectively),possibly reliable in 7 kinds of HDS,including Myrrh,peppermint,coenzyme Q_(10),chitosan,milkvetch root,avocado,and seaweed(5

关 键 词：中草药 营养保健品 华法林 草药-药物相互作用 抗凝血药 

分 类 号：R969[医药卫生—药理学]