Influence of Herbal Medicine Coadministration on the INR in Stroke Patients Taking Warfarin

뇌경색 환자의 Warfarin($Coumadin^{\circledR},{\;}Warfar^{\circledR}$) 복용시 한약물이 INR에 미치는 영향

  • 김은주 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 이상호 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 김이동 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 윤상필 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 이준우 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 홍진우 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 박영민 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 정우상 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실) ;
  • 조기호 (경희대학교 한의과대학 부속 한방병원 심계내과학 교실)
  • Published : 2004.06.01

Abstract

Objectives: Warfarin is a representative anticoagulant, and it has been the preferred drug for treating thromboembolic diseases and preventing ischemic stroke. It should be administered in a delicate manner, because combined therapy with other drugs could affect the INR (International Normalized Ratio), thus bleeding tendency might occur. Interaction with herbal medicines still remains controversial. We aimed to examine the effect of herbal medicine on INR in patients being treated with warfarin. We aimed to examine the effect of herbal medicine on INR in the patients being treated with warfarin. Methods: We enrolled subjects being treated with a combined therapy of warfarin and herbal medicine from 1 October, 2002 to 20 November, 2003 at the Department of Cardiovascular & Neurologic Diseases (Stroke Center), Hospital of Oriental Medicine, Kyung Hee Medical Center. INR was monitored per 1 to 2 weeks and the significance of change was examined by Wilcoxon signed rank test or repeated measure analysis Results: Eighty-three subjects were included in the final analysis. As a whole, their INR was not significantly changed. There were only 9 cases in which INR changed more than 1.0; 7 showed increasing tendency, and 2 showed decreasing tendency of INR. Among the 9 cases, only 5 were suspected to have a relation to herbal medicine. Conclusions: We suggest that there was no strong evidence that herbal medicine has an influence on INR, but there is a need to perform further evaluation on larger samples to reach a concrete conclusion.

Keywords

References

  1. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary
  2. Blood Coagul Fibrinolysis v.14 no.5 The use of a bolus of intravenous heparin while initiating heparin therapy in anticoagulation following transient ischemic attack or stroke does not lead to increased morbidity or mortality Toth C.
  3. 대한한방내과학회지 v.23 no.3 급성기 중풍환자에 대한 성향정기산의 임상적 효능 최동준;구본수;고창남;조기호;김영석;배형섭
  4. 일본동양의학잡지 v.53 no.6 뇌졸중발증초기환자에 대한 양격산화탕의 유효성의 검토 조기호;문상관
  5. Crit Nurse v.22 no.2 Herbal remedies: drug-herb interactions Kuhn MA
  6. 동서의학 진료 가이드 북 조기호
  7. J Thrombolysis v.12 no.1 Drug interactions update: drugs, herbs, and oral anticoagulation Wittkowsky AK
  8. The Annals of Pharmacotherapy v.34 Interactions of Warfarin with Garlic, Ginger, Ginkgo, or Ginseng: Nature of the Evidence Leon PJ Vaes;Peter A Chyka
  9. Blackwell Science Ltd Br J Clin Pharmacol. v.52 Herb-drug interactions: Review and assessment of report reliability Adriane Fugh-Berman;E. Ernst
  10. Ann Pharmacother v.35 Interaction between warfarin and danshen(Salvia miltiorrhiza) Chan TY
  11. Pharmacotherapy v.19 Potentiation of wafarin by dong quai Page RL;Lawrence JD
  12. AJHP v.59 Update on natural product-drug interactions Scott GN;Elmer GW
  13. Ann Pharmacother v.34 Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence Vaes LP;Chyka PA
  14. Neurology v.50 Association of Ginkgo biloba with intracerebral hemorrhage Matthews MK Jr.
  15. Am J Health Syst Pharm. v.54 Probable interactions between warfarin and ginseng Janetzky K;Morreale AP
  16. J Pharm Pharmacol. v.51 Possible influences of ginseng on the pharmacokinetics and pharmacodynamics of warfarin in rats Zhu M;Chan KW;Ng LS;Chang Q;Chang S;Li RC
  17. An update. Clin Pharmacokinet v.30 no.6 Clinically important drug interactions with anticoagulants. Harder S;Thurmann P
  18. Drug Saf. v.23 no.6 Antiarrhythmic agents: drug interactions of clinical significance Trujillo TC;Nolan PE
  19. Pharmacotherapy v.23 no.3 Effect of levofloxacin coadministration on the international normalized ratios during warfarin therapy Yamreudeewong W;Lower DL;Kilpatrick DM;Enlow AM;Burrows MM;Greenwood MC
  20. Ann Pharmacother v.36 no.10 Levofloxacin and warfarin interaction Jones CB;Fugate SE
  21. Int J Clin Pharmacol Ther. v.34 no.2 Further elucidation of pharmacokinetic interaction between diltiazem and warfarin Stoysich AM;Lucas BD;Mohiuddin SM;Hilleman DE
  22. Drugs Aging v.20 no.2 Drug treatment of epilepsy in elderly people: focus on valproic acid Stephen LJ
  23. Eur J Clin Pharmacol. v.55 no.11-12 Inhibition of human cytochrome P450 enzymes by 1,4-dihydropyridine calcium antagonists: prediction of in vivo drug-drug interactions Katoh M;Nakajima M;Shimada N;Yamazaki H;Yokoi T