Aspirin is an antiplatelet drug. At low dose (75-325 mg/d), it can effectively inhibit platelet aggregation and prevent the progression of atherosclerosis. Therefore, it can be used in atherosclerotic cardiovascular diseases such as coronary heart disease, cerebrovascular disease (ischemic cerebrovascular disease, transient ischemic attack), and peripheral arterial disease. Notoginseng powder is the powder of the root of Panax Notoginseng (Sanqi, Sanchi), a member of the ginseng family. It is rich in Panax notoginseng saponins (including diol saponins and triol saponins), notoginserin (trichtamic acid), flavones, volatile oils, amino acids, polysaccharides, etc. To achieve effect of hemostasis, promoting blood circulation, reducing swelling and pain, lowering blood fat and so on, Notoginseng powder’s suggested use is generally 3-9g/d. While having similar antithrombotic effects, can aspirin be taken together with Notoginseng powder?
First of all, in order to answer this question, we need to understand their underlying mechanism respectively.
Western medicine generally uses chemical monomer as its active ingredient. The composition is clear, and its target is specific. On the contrary, traditional Chinese medicine consists of multiple components. It works through multiple targets, focusing on multiple effects and the integrity of human body.
Low-dose aspirin irreversibly acetylates the cyclooxygenase 1 serine residue of the platelet arachidonic acid pathway through covalent bonding, thereby inhibiting the production of platelet thromboxane A2 (TXA2) and exerting an antithrombotic effect. But it does not inhibit all pathways of platelet aggregation.
Panax notoginseng powder achieves antithrombotic effects through multiple pathways. It can improve the function of vascular endothelum, reduce blood viscosity, inhibit platelet activation and aggregation. In addition, notoginseng inhibits the release platelet thromboxane A2, and the platelet aggregation induced by collagen, arachidonic acid, and adenosine diphosphate.Consequently, the combination of aspirin and Panax notoginseng powder has the benefit of synergistic treatment, increasing target sites, and prolongation of action time.
Secondly, let’s see the effect of aspirin and notoginseng on cerebrovascular system.
Thrombosis is the root cause of most cardiovascular and cerebrovascular diseases. Platelets participate in thrombosis through three stages: adhesion, aggregation, and release. Panax notoginseng saponins help to protect myocardium. It shows anti-arrhythmic and anti-myocardial ischemia effects, while regulating blood pressure and preventing atherosclerosis. In addition, it can also promote cerebral blood flow, inhibit platelet aggregation, and protect brain cells. Among the total saponins, heptenol saponins can reduce blood viscosity, improve microcirculation, and assist in the recovery of nerve function. On the other hand, Aspirin is an antiplatelet drug. Instead of showing thrombolytic effect on formed thrombus or embolisms, aspirin can only prevent the formation of new thrombus or embolisms. Therefore, notoginseng powder can enhance the efficacy of the therapy by adding protection to cerebral system.
Last but not least, we shall not neglect the side effect of aspirin as long-term use of aspirin increases the risk of bleeding and gastrointestinal mucosal injury. And some patients may also have aspirin resistance or intolerance. Panax notoginseng saponins can reduce the adverse reactions above. Thus, notoginseng powder can reduce the side effects of aspirin.
In summary, the combination of aspirin and Panax notoginseng can enhance the efficacy of the treatment and reduce the adverse health effects. But it should be noted that Panax notoginseng has bidirectional regulatory effect of Coagulation and anticoagulation because of the triketchisin in it has the function of hemostasis. Therefore, whether aspirin and notoginseng can be taken together should be based on the syndrome differentiation of Traditional Chinese medicine. Meanwhile, the coagulation status should be monitor as well.
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