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