Anticoagulant effect

抗凝血作用
  • 文章类型: Journal Article
    在这项研究中,从corb(Sciaenaumbra)头部提取糖胺聚糖(GAG),并彻底检查其结构。通过醋酸纤维素电泳,GAG被鉴定为硫酸软骨素(CS),回收率为10.35%。CS表现出显著的特征,包括高硫酸盐含量(12.4%)和38.32kDa的平均分子量。通过1HNMR光谱和SAX-HPLC的进一步分析显示,CS主要由交替单元组成,主要由GalNAc的6位和4位的单硫酸二糖组成(52.6%和38.8%,分别)。GalNAc的4位和6位之间的硫酸根基团的比率(4/6比率)为约0.74,导致0.98的总电荷密度。使用诸如差示扫描量热法和热重分析的技术评估CS的热性质。值得注意的是,CS显示活化部分凝血活酶时间(aPTT)和凝血酶时间(TT)浓度依赖性延长,而对血小板功能无影响.在200μg/mL时,aPTT和TT凝血时间比对照组快1.4和3.7倍,分别。这些发现表明,源自corbheads的CS有望作为治疗的抗凝剂。尽管需要进一步的临床研究来验证其疗效。
    In this study, glycosaminoglycans (GAGs) were extracted from corb (Sciaena umbra) heads and thoroughly examined for their structure. Through cellulose acetate electrophoresis, the GAGs were identified as chondroitin sulfate (CS), with a recovery yield of 10.35 %. The CS exhibited notable characteristics including a high sulfate content (12.4 %) and an average molecular weight of 38.32 kDa. Further analysis via 1H NMR spectroscopy and SAX-HPLC revealed that the CS primarily consisted of alternating units predominantly composed of monosulfated disaccharides at positions 6 and 4 of GalNAc (52.6 % and 38.8 %, respectively). The ratio of sulfate groups between positions 4 and 6 of GalNAc (4/6 ratio) was approximately 0.74, resulting in an overall charge density of 0.98. Thermal properties of the CS were assessed using techniques such as differential scanning calorimetry and thermogravimetric analysis. Notably, the CS demonstrated concentration-dependent prolongation of activated partial thromboplastin time (aPTT) and thrombin time (TT) while showing no effect on platelet function. At 200 μg/mL, aPTT and TT coagulation times were 1.4 and 3.7 times faster than the control, respectively. These findings suggest that CS derived from corb heads holds promise as an anticoagulant agent for therapy, although further clinical investigations are necessary to validate its efficacy.
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  • 文章类型: Journal Article
    血栓形成导致全球死亡率升高和大量医疗费用。人因子IXa(HFIXa)蛋白酶在组织因子(TF)介导的凝血酶生成中至关重要,并代表了抗凝治疗的一个有希望的目标。我们在本文中通过指数富集(SELEX)方法通过配体的系统进化分离特异性结合HFIXa的新型DNA适体。我们鉴定了两种不同的适体,seq5和seq11,显示对HFIXa的高结合亲和力(Kd=74.07±2.53nM,和4.93±0.15nM,分别)。计算机软件用于DNA适体和HFIXa结合的构象模拟和动力学分析。这些适体剂量依赖性地延长血浆中活化的部分凝血活酶时间(aPTT)。我们通过截短和定点突变进一步合理优化了适体,并生成了截断的形式(Seq5-1t,Seq11-1t)和截短的突变形式(Seq5-2tm,Seq11-2tm)。它们还显示出良好的抗凝血作用。合理和结构设计的解毒剂(seq5-2b和seq11-2b)竞争性地结合到DNA适体上,并有效地逆转了抗凝血作用。这种策略提供了DNA适体药物-解毒剂对有效抗凝和快速逆转,通过安全开发先进的疗法,可调节的适体药物-解毒剂对。
    Thrombosis leads to elevated mortality rates and substantial medical expenses worldwide. Human factor IXa (HFIXa) protease is pivotal in tissue factor (TF)-mediated thrombin generation, and represents a promising target for anticoagulant therapy. We herein isolated novel DNA aptamers that specifically bind to HFIXa through systematic evolution of ligands by exponential enrichment (SELEX) method. We identified two distinct aptamers, seq 5 and seq 11, which demonstrated high binding affinity to HFIXa (Kd = 74.07 ± 2.53 nM, and 4.93 ± 0.15 nM, respectively). Computer software was used for conformational simulation and kinetic analysis of DNA aptamers and HFIXa binding. These aptamers dose-dependently prolonged activated partial thromboplastin time (aPTT) in plasma. We further rationally optimized the aptamers by truncation and site-directed mutation, and generated the truncated forms (Seq 5-1t, Seq 11-1t) and truncated-mutated forms (Seq 5-2tm, Seq 11-2tm). They also showed good anticoagulant effects. The rationally and structurally designed antidotes (seq 5-2b and seq 11-2b) were competitively bound to the DNA aptamers and effectively reversed the anticoagulant effect. This strategy provides DNA aptamer drug-antidote pair with effective anticoagulation and rapid reversal, developing advanced therapies by safe, regulatable aptamer drug-antidote pair.
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  • 文章类型: Journal Article
    本研究调查了注射用红花黄色素(SYI)是否会影响华法林在大鼠体内的抗凝作用。Wistar雄性大鼠随机分为6组,给予SYI(9mg/kg,腹膜内注射)单剂量和稳定剂量华法林(0.2mg/kg,分别口服管饲法)。通过凝血分析仪测量PT和APTT的药效学参数。通过UHPLC-MS/MS测定R/S-华法林浓度,并使用DAS2.0软件计算药代动力学参数。单剂量研究表明,SYI,单独或与华法林联合给药,可以显着增加PT,INR,和APTT值(P<0.01)。R-华法林Cmax,AUC,t1/2值增加了9.25%(P>0.05),25.96%(P<0.01),分别为26.17%(P<0.01),而在SYI存在下,CL/F值降低了22.22%(P<0.01)。同时,S-华法林Cmax,AUC,t1/2值增加了37.41%,32.11%,分别为31.73%(P均<0.01),CL/F值降低了33.33%(P<0.01)。稳定剂量研究表明,PT,INR,APTT,SYI与华法林联合给药时,R/S-华法林的浓度显着增加(P<0.01)。SYI可以增强华法林的抗凝强度,减缓其在大鼠体内的代谢。
    This study investigated whether Safflower Yellow for injection (SYI) would affect the anticoagulation of warfarin in rats.Wistar male rats were divided into six groups randomly and administered with SYI (9 mg/kg, intraperitoneal injection) in single-dose and steady-dose warfarin (0.2 mg/kg, oral gavage), respectively. The pharmacodynamic parameters of PT and APTT were measured by a coagulation analyser. R/S-warfarin concentration was measured by UHPLC-MS/MS, and pharmacokinetic parameters calculated using DAS 2.0 software.The single-dose study demonstrated that SYI, alone or co-administered with warfarin, could significantly increase PT, INR, and APTT values (p < 0.01). R-warfarin Cmax, AUC, and t1/2 values increased by 9.25% (p > 0.05), 25.96% (p < 0.01), and 26.17% (p < 0.01), respectively, whereas the CL/F value reduced by 22.22% (p < 0.01) in the presence of SYI. Meanwhile, S-warfarin Cmax, AUC, and t1/2 values increased by 37.41%, 32.11%, and 31.73% (all p < 0.01), respectively, whereas the CL/F value reduced by 33.33% (p < 0.01). The steady-dose study showed that PT, INR, APTT, and the concentrations of R/S-warfarin increased significantly when SYI was co-administered with warfarin (p < 0.01).SYI can enhance warfarin\'s anticoagulation intensity and decelerate its metabolism in rats.
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  • 文章类型: Journal Article
    适应性药物释放可以对抗血液-材料界面处的凝血和炎症活化,具有最小化的副作用。为此,聚(苯乙烯-alt-马来酸酐)共聚物通过凝血响应接头肽与肝素缀合,并显示出从水溶液中以单层形式紧密吸附到聚(醚砜)(PES)表面上。未分级的以及低分子量肝素从各自的涂层中的凝血响应释放被证明在人血浆和全血孵育中具有功能上的益处,具有更快的释放动力学,导致更强的抗凝血作用。涂层聚(醚砜)/聚(乙烯基吡咯烷酮)(PES/PVP)平膜证明了该技术提供一种简单的,血液透析膜的有效和强大的抗凝血界面功能化。在透视中,自适应释放系统的模块化将用于抑制多个激活过程。
    Adaptive drug release can combat coagulation and inflammation activation at the blood-material interface with minimized side effects. For that purpose, poly(styrene-alt-maleic-anhydride) copolymers were conjugated to heparin via coagulation-responsive linker peptides and shown to tightly adsorb onto poly(ethersulfone) (PES)-surfaces from aqueous solutions as monolayers. Coagulation-responsive release of unfractionated as well as low molecular weight heparins from the respective coatings was demonstrated to be functionally beneficial in human plasma and whole blood incubation with faster release kinetics resulting in stronger anticoagulant effects. Coated poly(ethersulfone)/poly(vinylpyrrolidone) (PES/PVP) flat membranes proved the technology to offer an easy, effective and robust anticoagulant interfacial functionalization of hemodialysis membranes. In perspective, the modularity of the adaptive release system will be used for inhibiting multiple activation processes.
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  • 文章类型: Journal Article
    临床上,吲哚布芬广泛用于抗血小板聚集和抗凝治疗。先前的研究发现,当停药时,异常的血小板功能可以迅速恢复正常。在这里,通过对酶反应动力学的研究,我们证明吲哚布芬对环氧合酶-1(COX-1)的抑制作用是可逆的和非竞争性的。具体来说,环氧合酶抑制实验表明,吲哚布芬治疗组胃粘膜中6-酮-PGF1α的水平明显高于阿司匹林组(##p<0.001),表明胃粘膜的PGI2水平较高,生理状态较好。此外,大鼠胃溃疡指数和粘膜切片实验进一步证实,与阿司匹林组相比,吲哚布芬治疗组的胃肠道刺激减轻和不良反应发生率降低。此外,证实吲哚布芬对COX-1的血红素组具有可逆的抑制活性,从而可逆地抑制COX-1活性。总的来说,与阿司匹林相比,长期口服吲哚布芬可以降低胃肠道症状的风险,如溃疡。
    Clinically, indobufen is widely used for the treatment of antiplatelet aggregation and anticoagulation. Prior studies have discovered that abnormal platelet function can be promptly restored to normal when the drug is stopped. Herein, through the study of the enzyme reaction kinetics, we demonstrated that the inhibitory effect of indobufen on cyclooxygenase-1 (COX-1) was reversible and non-competitive. Specifically, the cyclooxygenase inhibition experiment showed that the level of 6-keto-PGF1α in the gastric mucosa of the indobufen-treated groups was significantly higher than that of the aspirin group (###p < 0.001), indicating a higher level of PGI2 in and a better physiological state of the gastric mucosa. Moreover, the rat gastric ulcer index and mucosal section experiments further confirmed the relief of gastrointestinal irritation and the adverse reaction rate of the indobufen-treated group compared to those of the aspirin group. Furthermore, indobufen was verified to exert reversible inhibitory activity on the heme group of COX-1 and thus reversibly inhibit COX-1 activity. In general, compared with aspirin, the long-term oral administration of indobufen yields a lower risk of gastrointestinal symptoms, such as ulcers.
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  • 文章类型: Journal Article
    本研究基于谱效关系-整合分子对接,探索天花粉及其壳核抗凝血的物质基础和作用机理。建立了天花粉及其壳和仁的高效液相色谱(HPLC)指纹图谱。低剂量和高剂量小鼠的凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)(5,30g·kg〜(-1),分别)天花粉精液,贝壳,和内核组被确定为凝血标志物。采用邓氏关联度均值计算方法(MATLAB)对天花粉及其壳核的谱-效应关系和抗凝物质基础进行了分析,得到了常见的有效成分聚类。然后从TCMSP中检索组分簇和凝血的共同靶标,瑞士目标预测,GenCLiP3,GeneCards,和大卫,其次是基因本体论(GO)术语富集和京都基因和基因组百科全书(KEGG)途径富集的目标。SYBYL-X2.1.1验证了组分簇的主要抗凝血分子机制。天花粉及其壳核的谱效关系与剂量呈正相关。每种成分对抗凝的贡献并不相同,表明抗凝的物质基础是不同的,但它们具有共同的有效成分(即共同的物质基础),如腺嘌呤(峰3),尿嘧啶(峰值4),次黄嘌呤(峰6),黄嘌呤(峰9),和腺苷(峰11)。网络药理学表明,这些成分可以作用于多种靶蛋白,如NOS3,KDR,和PTGS2,并通过多种途径如VEGF信号通路发挥抗凝作用。它们涉及蛋白质水解等生物学功能,细胞成分,如细胞质,和分子功能。分子对接结果表明,这些组分与NOS3(PDBID:1D0C)的结合自由能,KDR(PDBID:5AMN),PTGS2(PDBID:4COX)≤-5kJ·mol~(-1),对接构象稳定。光谱-效应关系-整合分子对接可用于优化,虚拟筛选,复杂的中药化学和生物信息的验证。天花粉及其壳核具有共同的抗凝物质基础,通过多种靶点和途径发挥抗凝作用。
    This study explored the anticoagulant material basis and mechanism of Trichosanthis Semen and its shell and kernel based on spectrum-effect relationship-integrated molecular docking. High performance liquid chromatography(HPLC) fingerprints of Trichosanthis Semen and its shell and kernel were established. Prothrombin time(PT) and activated partial thromboplastin time(APTT) in mice in the low-and high-dose(5, 30 g·kg~(-1), respectively) Trichosanthis Semen, the shell, and kernel groups were determined as the coagulation markers. The spectrum-effect relationship and anticoagulant material basis of Trichosanthis Semen and its shell and kernel were analyzed with mean value calculation method of Deng\'s correlation degree(MATLAB) and the common effective component cluster was obtained. Then the common targets of the component cluster and coagulation were retrieved from TCMSP, Swiss-TargetPrediction, GenCLiP3, GeneCards, and DAVID, followed by Gene Ontology(GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment of the targets. The main anticoagulant molecular mechanism of the component cluster was verified by SYBYL-X 2.1.1. The spectrum-effect relationship of Trichosanthis Semen and its shell and kernel was in positive correlation with the dosage. The contribution of each component to anticoagulation was not the same, suggesting that the material basis for anticoagulation was different, but they have common effective components(i.e. common material basis), such as adenine(peak 3), uracil(peak 4), hypoxanthine(peak 6), xanthine(peak 9), and adenosine(peak 11). Network pharmacology showed that these components can act on multiple target proteins such as NOS3, KDR, and PTGS2, and exert anticoagulant effect through multiple pathways such as VEGF signaling pathway. They involved the biological functions such as proteolysis, cell component such as cytosol, and molecular functions. The results of molecular docking showed that the binding free energy of these components with NOS3(PDB ID: 1 D0 C), KDR(PDB ID: 5 AMN), and PTGS2(PDB ID: 4 COX) was ≤-5 kJ·mol~(-1), and the docking conformations were stable. Spectrum-effect relationship-integrated molecular docking can be used for the optimization, virtual screening, and verification of complex chemical and biological information of Chinese medicine. Trichosanthis Semen and its shell and kernel have the common material basis for anticoagulation and they exert the anticoagulant through multiple targets and pathways.
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  • 文章类型: Journal Article
    蜂毒(BV)是自古以来一直是研究主题的最著名的天然产物之一。最近的研究表明,蜜蜂蛇毒对癌细胞具有抗菌和细胞毒性作用。毒液中含有多种生物活性分子-主要是蜂毒素(MEL)和磷脂酶A2(PLA2),以及其他没有很好表征的化合物。在这项工作中,我们通过使用凝血酶原时间(PT)测试来测试其对人血浆的抗凝血作用,继续进行A.melliferasyriaca毒的生物学表征,以及评估其蛋白水解活性。此外,粗毒液及其两种主要成分的细胞毒性,MEL和PLA2-首次在HeLa癌细胞系上测试。获得的结果表明,A.melliferasyriaca毒增加凝血时间的能力,从而证明其抗凝作用。此外,除非以≥5mg/mL的浓度给药,否则毒液没有显示出明显的蛋白水解活性。最后,我们展示了粗A.melliferasyriaca毒液,和MEL一起,对HeLa癌细胞系表现出强烈的体外细胞毒性作用,即使在低浓度。总之,我们的发现可以作为治疗领域开发新的天然药物候选物的基础.
    Bee venom (BV) is one of the most remarkable natural products that has been a subject of studies since ancient times. Recent studies have shown that Apis mellifera syriaca venom possesses antibacterial as well as cytotoxic effects on cancer cell lines. The venom contains a variety of bioactive molecules-mainly melittin (MEL) and phospholipase A2 (PLA2), as well as other compounds that are not well characterized. In this work, we continue the biological characterization of A. mellifera syriaca venom by testing its anticoagulant effect on human plasma using the prothrombin time (PT) test, as well as assessing its proteolytic activity. In addition, the cytotoxicity of the crude venom-and of its two main components, MEL and PLA2-was tested on HeLa cancer cell lines for the first time. The results obtained showed the capacity of A. mellifera syriaca venom to increase clotting time, thereby proving its anticoagulant effect. Moreover, the venom did not demonstrate a significant proteolytic activity unless administrated at concentrations ≥ 5 mg/mL. Finally, we showed that crude A. mellifera syriaca venom, along with MEL, exhibit a strong in vitro cytotoxic effect on HeLa cancer cell lines, even at low concentrations. In summary, our findings could serve as a basis for the development of new natural-based drug candidates in the therapeutic field.
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  • 文章类型: Journal Article
    背景:为了研究影响华法林抗凝作用的各种因素,促进华法林的合理使用。
    方法:我们收集了2018年1月至2019年12月使用华法林的125例住院患者的病历。对性别、年龄,治疗,糖尿病,高脂血症,甲状腺功能亢进,甲状腺功能减退,肝炎,肾功能不全,和肾炎;以及其他病理因素,比如阿司匹林,氯吡格雷,螺内酯,胺碘酮,氨氯地平,曲美他嗪,比索洛尔,异山梨醇,阿托伐他汀,呋塞米,地高辛,美托洛尔,阿卡波糖,左旋氨氯地平,依诺肝素,莫西沙星,左氧氟沙星,其他药物相互作用,和合并症。
    结果:性别和年龄对华法林的疗效没有显著影响。感染和出血延长了华法林给药的天数。阿卡波糖,依诺肝素,和莫西沙星可能对华法林治疗相关指标有影响.
    结论:华法林抗凝受到多种因素的影响。因此,医务人员应密切关注这些因素对华法林抗凝效果的影响。本研究发现华法林相关出血不良反应与抗凝作用有显著关联。出血不仅影响住院天数,而且延长了华法林给药的天数。然而,就患者的病理状态而言,国际标准化比率值与所用药物没有相关性,可能仅作为出血风险的参考.
    BACKGROUND: To study the various factors affecting the anticoagulant effect of warfarin, and to promote the rational use of warfarin.
    METHODS: We collected the medical records of 125 hospitalized patients who used warfarin from January 2018 to December 2019. Statistical analysis was performed on characteristics such as gender, age, treatment, diabetes, hyperlipidemia, hyperthyroidism, hypothyroidism, hepatitis, renal insufficiency, and nephritis; along with other pathological factors, such as aspirin, clopidogrel, spironolactone, amiodarone, amlodipine, trimetazidine, bisoprolol, isosorbide, atorvastatin, furosemide, digoxin, metoprolol, acarbose, levamlodipine, enoxaparin, moxifloxacin, levofloxacin, other drug interactions, and comorbidities.
    RESULTS: Gender and age did not have a significant effect on the efficacy of warfarin. Infection and bleeding extended the number of days of warfarin administration. Acarbose, enoxaparin, and moxifloxacin had a likely effect on warfarin treatment-related indicators.
    CONCLUSIONS: Warfarin anticoagulation is affected by many factors. Therefore, medical personnel should pay close attention to the impact of these factors on the anticoagulant effect of warfarin. This study found that warfarin-related bleeding adverse drug reactions and anticoagulant effects have a significant association. Bleeding not only affected the total number of days hospitalized, but also extended the number of days of warfarin administration. However, in terms of patients\' pathological states, international normalized ratio values combined with drugs used were not associated with disease and may only be a reference for bleeding risk.
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  • 文章类型: Journal Article
    前蛋白转化酶枯草杆菌蛋白酶/kexin9型(PCSK-9)抑制剂是一组药物,其主要作用机制是与PCSK-9分子结合,这减少了低密度脂蛋白受体(LDL-R)的降解,因此,增加血液中低密度脂蛋白胆固醇(LDLc)的摄取,并降低其浓度。三种单克隆抗体的有效性,即,alirocumab(人IgG1/κ单克隆抗体,中国仓鼠卵巢细胞基因工程),evolocumab(第一个完全人类单克隆抗体),和bococizumab(人源化小鼠抗体),已证实抑制PCSK-9的作用和降低LDLc水平。前两个,经过临床试验,已获得食品和药物管理局(FDA)的批准,主要用于治疗常染色体家族性高胆固醇血症和他汀类药物不耐受的情况。目前,它们既用作单一疗法,也与他汀类药物和依泽替米贝联合使用,以按照美国心脏协会(AHA)和欧洲心脏病学会(ESC)指南加强治疗并实现治疗目标。然而,降脂作用并不是研究人员描述的PCSK-9抑制剂具有的唯一作用。本文综述了PCSK-9抑制剂的多效性文献,属于越来越多使用的一组药物,尤其是标准降脂治疗失败时。文章重点介绍降脂以外的其他活动,如抗动脉粥样硬化作用和动脉粥样硬化斑块的稳定,抗聚集效果,抗凝作用,抗肿瘤作用,以及影响细菌感染进程的能力。在本出版物中,我们试图系统地回顾当前的科学数据,来自我们自己的科学工作和国际出版物的知识。
    Proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors are a group of drugs whose main mechanism of action is binding to the PCSK-9 molecule, which reduces the degradation of the low-density lipoprotein receptor (LDL-R) and, hence, increases the uptake of low-density lipoprotein cholesterol (LDLc) from the bloodstream as well as reducing its concentration. The effectiveness of three monoclonal antibodies, namely, alirocumab (human IgG1/κ monoclonal antibody, genetically engineered in Chinese hamster ovary cells), evolocumab (the first fully human monoclonal antibody), and bococizumab (humanized mouse antibody), in inhibiting the action of PCSK-9 and reducing LDLc levels has been confirmed. The first two, after clinical trials, were approved by the Food and Drug Administration (FDA) and are used primarily in the treatment of autosomal familial hypercholesterolemia and in cases of statin intolerance. They are currently used both as monotherapy and in combination with statins and ezetimibe to intensify therapy and achieve therapeutic goals following the American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines. However, the lipid-lowering effect is not the only effect of action described by researchers that PCSK-9 inhibitors have. This paper is a review of the literature describing the pleiotropic effects of PCSK-9 inhibitors, which belong to a group of drugs that are being increasingly used, especially when standard lipid-lowering therapy fails. The article focuses on activities other than lipid-lowering, such as the anti-atherosclerotic effect and stabilization of atherosclerotic plaque, the anti-aggregation effect, the anticoagulant effect, the antineoplastic effect, and the ability to influence the course of bacterial infections. In this publication, we try to systematically review the current scientific data, both from our own scientific work and knowledge from international publications.
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  • 文章类型: Journal Article
    This study is to explore the effect of Xiangdan Injection on anticoagulation of warfarin in rats. Rats were randomly divided into different groups and then administered, subsequently the blood samples were collected at a set series of time points to measure PT(prothrombin time) and APTT(activated partial thromboplastin time) values, and INR(international normalized ratio) value was calculated. The plasma concentrations of warfarin enantiomers were determined by UPLC-MS/MS technology, and pharmacokinetic parameters were calculated by DAS 2.0 software. Statistical analysis was performed to compare differences between the groups. Single-dose study of warfarin showed that Xiangdan Injection alone had no effects on PT, APTT and INR, but when co-administrated with warfarin, PT and INR values were increased(P<0.01), while APTT was unaffected; after co-administration of the two drugs, C_(max), AUC_(0-t), and AUC_(0-∞) of S-warfarin increased(P<0.01), and t_(1/2) prolonged(P<0.01), while the pharmacokinetic parameters of R-warfarin were not changed significantly. Steady-state study of warfarin showed that after co-administration of the two drugs, the PT and INR values increased(P<0.05), and the plasma concentration of S-warfarin increased(P<0.01), while the plasma concentration of R-warfarin was not changed significantly. The results suggest that Xiangdan Injection itself has no effect on coagulation index, but can enhance the anticoagulant effect of warfarin by slowing metabolism of S-warfarin.
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