Abstract: Warfarin is a double coumarin anticoagulant commonly used in clinic. It is widely used in the adjuvant treatment of cardiovascular and cerebrovascular diseases and in the prevention and treatment of thromboembolic diseases. However, its treatment window is narrow, individual differences are huge, and warfarin interacts with a variety of drugs and foods, which is likely to lead to the risk of bleeding or insufficient anticoagulation. Traditional Chinese medicines for promoting blood circulation and removing blood stasis are widely used in the treatment of cardiovascular diseases, and there are many cases where warfarin is used in combination with TCM. Such combination, however, can increase the risk of bleeding. By consulting the literature, this paper found that the mechanism by which traditional Chinese medicines for promoting blood circulation and removing blood stasis can enhance the anticoagulant effect of warfarin mainly involves the interactions of pharmacokinetics and pharmacodynamic effects. It is recommended that when traditional Chinese medicines for activating blood circulation and removing blood stasis and warfarin are used together in clinical practice, the international standardized ratio of patients should be closely monitored, and the dosage of warfarin should be appropriately adjusted in order to prevent the combination of traditional Chinese medicines with additive effects and ensure safe and rational use of drugs.

Key words: promoting blood circulation and removing blood stasis, traditional Chinese medicine, warfarin, anticoagulation, cytochrome P450 enzyme, INR