Clarian Health, Indianapolis, IN, USA.
Am J Health Syst Pharm. 2009 Dec 1;66(23):2117-22. doi: 10.2146/ajhp090282.
Recent evidence of a potential interaction between clopidogrel and proton pump inhibitors (PPIs) is discussed.
The American College of Cardiology and the American Heart Association recommend use of gastroprotective agents, specifically PPIs, in patients receiving aspirin, a thienopyridine, or the combination who have an increased risk for recurrent gastrointestinal bleeding. Available evidence from one small, short-term, randomized, double-blind trial evaluating platelet aggregation and several observational studies suggests that there is a potential for a clinically significant interaction between clopidogrel and PPIs. A post hoc analysis of a large, randomized, double-blind trial found no evidence of a clinically significant drug interaction at 28 days, though a significant difference was observed at one year. The authors concluded that the use of PPIs, regardless of clopidogrel use, increases the risk of adverse cardiovascular events.
Although data are limited, observational studies and prospective trials involving surrogate markers of platelet reactivity suggest a clinically significant interaction between clopidogrel and PPIs. Until further studies are completed to delineate the specifics of the interaction between clopidogrel and PPIs, the risks and benefits of concomitant treatment should be carefully weighed to determine the most appropriate treatment for each individual patient.
讨论氯吡格雷与质子泵抑制剂（PPIs）之间潜在相互作用的最新证据。
美国心脏病学会和美国心脏协会建议在接受阿司匹林、噻吩吡啶或两者联合治疗且有复发性胃肠道出血风险增加的患者中使用胃保护剂，特别是质子泵抑制剂。一项评估血小板聚集的小型短期随机双盲试验和几项观察性研究的现有证据表明，氯吡格雷与质子泵抑制剂之间存在潜在的临床显著相互作用。一项大型随机双盲试验的事后分析发现，在 28 天内没有临床显著药物相互作用的证据，但在一年时观察到显著差异。作者得出结论，无论是否使用氯吡格雷，质子泵抑制剂的使用都会增加不良心血管事件的风险。
尽管数据有限，但涉及血小板反应性替代标志物的观察性研究和前瞻性试验表明，氯吡格雷与质子泵抑制剂之间存在临床显著相互作用。在完成进一步研究以阐明氯吡格雷与质子泵抑制剂之间相互作用的具体细节之前，应仔细权衡同时治疗的风险和益处，以确定每个患者的最佳治疗方案。
