影响华法林抗凝血作用的有关因素

Related factors affecting anticoagulant effect of warfarin

华法林为口服抗凝血药,用于治疗和预防血栓栓塞性疾病。华法林抗凝血作用(增强或减弱)受多种因素影响。这些因素包括遗传、疾病、药物、草药以及食物等。CYP2C9多态性(主要为CYP2C9*2、CYP2C9*3)、肝功能低下、甲状腺功能亢进、心力衰竭以及阿司匹林、氯吡格雷、咪康唑、当归、茴香、芹菜、菠萝、洋葱、大蒜等和华法林的相互作用均能致华法林抗凝血作用增强。而VKORC1的基因突变以及利福平、卡马西平、人参、绿茶,富含维生素K的制剂或饮食等和华法林相互作用均能使华法林抗凝血作用减弱。另外,有些药物如:苯妥英钠,既能增强又能减弱华法林的抗凝血作用。了解这些因素对华法林抗凝血作用的影响,定期监测INR值,进行个体化给药,有利于华法林安全有效应用。

Warfarin is an oral anticoagulant used in the treatment and prophylaxis ofthromboembolic disorders. Many factors affect warfarin＇s anticoagulant effect （enhancement or diminishment）. These factors include genetics, diseases, drugs, herbal medicines, food, etc. Several polymorphisms of CYP2C9 （mainly CYP2C9＊2 and CYP2C9＊3）, liver function insufficiency, hyperthyroidism, heart failure, and interactions of warfarin with aspirin, clopidogrel, miconazole, angelica, fennel, celery, pineapple, onion, and garlic enhance the anticoagulant effect of warfarin. Gene mutation of VKORC1 and interactions of warfarin with rifampicin, carbamazepine, ginseng, green tea, and plenty vitamin K-containing preparations or diets diminish the anticoagulant effect of warfarin. Further more, some drugs such as phenytoin sodium can increase as well as decrease warfarin＇s anticoagulant effect. Understanding of these factors affecting the anticoagulant effect of warfarin, regular monitoring oflNR, and individualizing medication are beneficial to safe and effective use of warfarin.