The Absence of an Interaction Between Warfarin and Cranberry Juice: A Randomized, Double-Blind Trial
The Absence of an Interaction Between Warfarin and Cranberry Juice: A Randomized, Double-Blind Trial
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DOI：
10.1177/0091270009337510
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发表时间：
2009-07-01
影响因子：
2.9
通讯作者：
Greenblatt, David J.
中科院分区：
文献类型：
--
作者：
Ansell, Jack;McDonough, Maryellen;Greenblatt, David J.
蔓越莓汁（CJ）增强华法林抗凝作用的问题是一个具有生物医学重要性的话题。关于CJ-华法林相互作用的传闻报告在对照研究中大部分未得到证实。30例稳定华法林抗凝治疗的患者（国际标准化比值[ INR]，1.7-3.3）随机接受240 mL CJ或240 mL安慰剂饮料，颜色和味道匹配，每日一次，持续2周。在2周期间和1周随访期间测量INR值和R-和S-华法林的血浆水平。CJ和安慰剂组（分别为n = 14和16）的平均血浆R-和S-华法林浓度无显著差异。8例患者（CJ组4例，安慰剂组4例）在治疗期间发生INR极轻微升高（范围，3.38-4.52）。平均INR仅在治疗第12天有显著差异（P <0.02）;在所有其他时间点，各组无差异。蔓越莓汁对血浆S-或R-华法林血浆水平没有影响，排除药代动力学相互作用。CJ在单个时间点对INR的小的但具有统计学显著性的药效学增强不太可能具有临床意义，可能是随机变化。轶事报告中归因于CJ的华法林抗凝增强可能代表偶然的时间关联。
The question of potentiation of warfarin anticoagulation by cranberry juice (CJ) is a topic of biomedical importance. Anecdotal reports of CJ-warfarin interaction are largely unconfirmed in controlled studies. Thirty patients on stable warfarin anticoagulation (international normalized ratio [ INR], 1.7-3.3) were randomized to receive 240 mL of CJ or 240 mL of placebo beverage, matched for color and taste, once daily for 2 weeks. The INR values and plasma levels of R- and S-warfarin were measured during the 2-week period and a 1-week follow-up period. The CJ and placebo groups (n = 14 and 16, respectively) did not differ significantly in mean plasma R- and S-warfarin concentrations. Eight patients (4 on CJ, 4 on placebo) developed minimally elevated INR (range, 3.38-4.52) during the treatment period. Mean INR differed significantly (P < .02) only on treatment day 12; at all other time points, the groups did not differ. Cranberry juice has no effect on plasma S- or R-warfarin plasma levels, excluding a pharmacokinetic interaction. A small though statistically significant pharmacodynamic enhancement of INR by CJ at a single time point is unlikely to be clinically important and may be a random change. Enhanced warfarin anticoagulation attributed to CJ in anecdotal reports may represent a chance temporal association.