Cryer Byron
Department of Veterans Affairs Medical Center, Medical Service, Digestive Diseases, North Texas VA Medical Center, 4500 S Lancaster Road, Dallas, TX 75216, USA.
Gastroenterol Clin North Am. 2009 Jun;38(2):289-303. doi: 10.1016/j.gtc.2009.03.005.
Increasing use of antiplatelet therapies is associated with increasing GI complications, such as ulceration and GI bleeding. Identification of high-risk patients and, in such patients, incorporation of strategies to reduce their GI risk would be clinically prudent. After assessment and treatment of H pylori in patients with prior ulcer or GI bleeding histories, further reduction in GI risk in other high-risk patients who require antiplatelet agents is primarily accomplished by prescribing drugs that when coadministered with antiplatelet agents protect against mucosal ulceration, primarily proton pump inhibitors (PPIs). However, observational studies indicate a higher cardiovascular event rate in patients taking PPIs along with clopidogrel and aspirin compared with that of patients undergoing dual antiplatelet therapy without PPIs. Whether concurrent use of a PPI with clopidogrel represents a safety concern or not is currently being evaluated by the US Food and Drug Administration. Until more specific regulatory guidance is available, current recommendations are that patients taking both PPIs and clopidogrel concurrently should probably continue to do so until more data become available.
抗血小板治疗的使用增加与胃肠道并发症（如溃疡和胃肠道出血）的增加相关。识别高危患者，并在此类患者中采用降低其胃肠道风险的策略在临床上是审慎的做法。在对有既往溃疡或胃肠道出血病史的患者进行幽门螺杆菌评估和治疗后，对于其他需要抗血小板药物的高危患者，进一步降低胃肠道风险主要通过开具与抗血小板药物合用时能预防黏膜溃疡的药物来实现，主要是质子泵抑制剂（PPI）。然而，观察性研究表明，与未使用PPI进行双联抗血小板治疗的患者相比，同时服用PPI与氯吡格雷和阿司匹林的患者发生心血管事件的几率更高。PPI与氯吡格雷同时使用是否存在安全问题目前正在由美国食品药品监督管理局进行评估。在获得更具体的监管指导之前，目前的建议是，同时服用PPI和氯吡格雷的患者可能应继续如此用药，直到有更多数据可用。
