中国药物警戒 ›› 2025, Vol. 22 ›› Issue (11): 1217-1222.
DOI: 10.19803/j.1672-8629.20250658

• 中西药联用的风险调控与预警研究专栏 • 上一篇    下一篇

华法林联用中药的出血风险与联用机制研究

赵子仪1, 鲁程锦2, 张晓朦2,3#, 黄怀娟2, 张冰2,3*   

  1. 1北京中医药大学中医学院,北京 102488;
    2北京中医药大学中药学院,北京 102488;
    3北京中医药大学中药药物警戒与合理用药研究中心,北京 102488
  • 收稿日期:2025-09-15 出版日期:2025-11-15 发布日期:2025-11-14
  • 通讯作者: *张冰,女,博士,主任医师,教授·博导,中药防治代谢性疾病、中药药物警戒与合理用药。E-mail: zhangb@bucm.edu.cn,#为共同通信作者。
  • 作者简介:赵子仪,女,在读本科,中药药物警戒研究。
  • 基金资助:
    国家自然科学基金资助项目（82204643）; 国家中医药管理局高水平重点学科建设项目-临床中药学 （zyyzdxk-2023257）

Bleeding Risk and Interactions of Warfarin Combined with Traditional Chinese Medicine

ZHAO Ziyi1, LU Chengjin2, ZHANG Xiaomeng2,3#, HUANG Huaijuan2, ZHANG Bing2,3*   

  1. 1School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102488, China;
    2School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China;
    3Center for Pharmacovigilance and Rational Use of Chinese Medicines, Beijing University of Chinese Medicine, Beijing 102488, China
  • Received:2025-09-15 Online:2025-11-15 Published:2025-11-14

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摘要： 目的 探讨华法林与中药联用的出血风险,并分析其相互作用机制,为临床合理联用提供依据。方法 检索2000年1月1日至2025年6月30日中国知网、万方数据、中国生物医学文献服务系统等数据库,挖掘华法林致出血风险因素及联用中药特征,并采用网络药理学、分子对接等探索华法林与联用中药的相互作用机制。结果 纳入华法林致出血病例79例,联用中药并未增加华法林治疗初期的出血风险（P>0.05）。华法林常与“丹参-麦冬”等药对联用,发挥养阴活血作用,且与华法林共同作用于PI3K-Akt信号通路、脂质与动脉粥样硬化等通路,并与STAT3、ESR1等关键靶点具有较强的结合能力。结论 本研究从临床风险、用药规律到相互作用机制提供了初步证据,表明华法林与中药在一定条件下具有联用基础,但需要加强其药学监护,并开展针对性的风险分级管理研究。

关键词: 华法林, 联用中药, 出血风险, 丹参-麦冬, 联用机制, 药物警戒

Abstract: Objective To investigate the bleeding risk associated with the concomitant use of warfarin and traditional Chinese medicine (TCM), and the underlying mechanisms for interactions in order to provide evidence for rational clinical co-administration. Methods Such databases as CNKI, Wanfang and Sinomed were searched for literature published between January 1, 2000 and June 30, 2025 to perform data mining on risk factors for warfarin-induced bleeding and the characteristics of TCM used in combination. Network pharmacology and molecular docking were employed to explore potential pharmacological interactions between warfarin and commonly co-administered TCM. Results Seventy-nine cases of warfarin-related bleeding were retrieved in the analysis. The concurrent use of TCM did not significantly increase the risk of bleeding during the initial phase of warfarin therapy (P>0.05). Data mining revealed frequent co-prescription patterns, particularly the herb pair SALVIA MILTIORRHIZA RADIX (Danshen) and OPHIOPOGONIS RADIX (Maidong), which were traditionally used to nourish yin and promote blood circulation. Pathway enrichment analysis indicated that these herbs and warfarin might work together to modulate key signaling pathways such as the PI3K-Akt pathway, lipid metabolism, and atherosclerosis. Molecular docking results demonstrated strong binding affinities between the active components of these herbs and critical targets including STAT3 and ESR1. Conclusion The study has offered evidence about clinical risks, patterns of medications, and interaction mechanisms that suggests warfarin can be used in combination with TCM under some conditions. However, enhanced pharmaceutical surveillance and more research on risk stratification are warranted to ensure patients' safety.

Key words: Warfarin, Combined Use of Traditional Chinese Medicine, Bleeding Risk, Interaction Mechanism, SALVIA MILTIORRHIZA RADIX and OPHIOPOGONIS RADIX, Pharmacovigilance

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