found that CYP3A4 em ? /em 1G had no significant effect on clopidogrel resistance; however Rui Liu et al

found that CYP3A4 em ? /em 1G had no significant effect on clopidogrel resistance; however Rui Liu et al. and easing adverse reactions. Danshen inhibited carboxylesterase 1 and most enzyme of cytochrome P450, especially cytochrome P450 1A2, which may affect the metabolism of clopidogrel. Conclusion Danshen combined with clopidogrel may compensate for individual differences of clopidogrel resistance among individuals in the treatment of coronary heart disease. Meanwhile, the inhibitory effect of Danshen on cytochrome P450 and carboxylesterase 1 could be partly responsible for the synergistic and attenuating effects of Danshen combined with clopidogrel. 1. Introduction Danshen (Salviae miltiorrhizae, Chinese sage, Radix Salviae miltiorrhiza, red sage, danshen, Tan Shen) is the root and rhizome ofSalvia miltiorrhizaBunge. Danshen, a traditional herbal medicine in China, had been used to treat irregular menstruation, cold hernia, and abdominal pain, because the theory of traditional Chinese medicine holds that it activates blood circulation to dissipate blood stasis, calming, and relieving pain [1]. Today, Danshen has proved effective in organ protection, brain protection, and S3QEL 2 antitumour action, and the most widely used is usually in the field of cardiovascular disease. Researchers proved that, in China, nearly all ( 99% ) hospitals used early intravenous traditional herbal medicine for acute myocardial infarction, and Danshen accounts for the first three of these herbs. Patients receiving early intravenous herbal medicine may have fewer cardiovascular risk factors [2]. Meta-analysis showed that Danshen depside salts, extracted (as dry extract, refined) from the dried root of Danshen Bunge, combined with conventional treatment, were superior to conventional treatment alone in improving angina symptoms; bioinformatics analysis found that Danshen depside salts may targetjun, tnf, nfkb, fos, and bcl-2exerts effects against cardiovascular disease [3, 4]. In view of the antioxidant [5], S3QEL 2 anti-inflammatory [6], antiapoptotic [7], and cardioprotective S3QEL 2 effects [8] of Danshen, it is often used in combination with other drugs. Atorvastatin is an effective lipid-lowering drug without mentioning its side effects. Studies showed that atorvastatin combined with Danshen and Pueraria lobata yielded stronger hypolipidemic effects and fewer side effects than atorvastatin used alone [9]. In terms of prevention and treatment of thrombotic diseases, Danshen is also used in combination with other drugs: the combination of Danshen and aspirin can more effectively treat patients with coronary heart disease Klf5 (CHD), especially those with diabetes or hyperlipidaemia [10]; Danshen can enhance the antiplatelet effect of clopidogrel by prolonging bleeding time of coagulation parameters, restraining arteriovenous bypass thrombosis [11]. Clopidogrel, as an adenosine diphosphate receptor antagonist, is usually widely used in cardiocerebrovascular disease. Researchers found that clopidogrel can effectively improve the clinical symptoms and haemodynamic indexes of patients with CHD by reducing the platelet aggregation rate and decreasing the inside thrombosis, thus improving microvascular endothelial function. However, researchers have also revealed that clopidogrel has individual differences in the treatment of CHD. Some researchers declared that this situation may be related to clopidogrel resistance or high on-treatment platelet reactivity, and evidence showed that older patients were more likely to be having high on-treatment platelet reactivity and resistance to clopidogrel [12, 13]. For those with low clopidogrel response, clopidogrel was for the most part overdosed, which appeared to be ineffective in branch atherosclerotic diseases [14, 15] or was switched to other drugs such as prasugrel or ticagrelor or used in combination with other medications [16, 17]. Research illustrated that clopidogrel combined with aspirin caused a lower recurrence rate of coronary artery disease in the S3QEL 2 first 12 months after coronary artery bypass grafting compared to the addition of.