Allen Christopher, Dunn Steven P, Macaulay Tracy E, Mukherjee Debabrata
Department of Internal Medicine and Division of Cardiology, University of Kentucky, Lexington, Kentucky 40536-0200, USA.
Cardiovasc Hematol Disord Drug Targets. 2010 Mar;10(1):66-72. doi: 10.2174/187152910790780078.
The European Medicines Agency (EMEA) recently issued a public statement on a possible interaction between clopidogrel and proton pump inhibitors (PPIs) and recommended that the product information for all medicines containing clopidogrel be amended to discourage concomitant use of PPIs unless absolutely necessary. This follows a prior alert issued by the United States Food and Drug Administration (FDA) earlier this year, stating that PPIs might interfere with the effectiveness of clopidogrel and that clinicians should reevaluate starting or continuing treatment with a PPI in patients taking clopidogrel. However, several experts have voiced their concern that the clopidogrel-PPI interaction has been given undue importance, given that all clinical studies suggesting this problem are observational. In this review, we critically analyze the available data and make practical suggestions for the clinician regarding appropriate use of PPIs in patients receiving clopidogrel. Based on currently available evidence, we suggest that the decision to prescribe a PPI to a patient on clopidogrel must be made on an individual patient basis balancing the gastrointestinal risk with the possible thrombotic risk and that PPIs should only be used for truly appropriate indications.
欧洲药品管理局（EMEA）最近就氯吡格雷与质子泵抑制剂（PPIs）之间可能存在的相互作用发布了一份公开声明，并建议修订所有含氯吡格雷药品的产品信息，以不鼓励同时使用PPIs，除非绝对必要。这是继美国食品药品监督管理局（FDA）今年早些时候发布的一份警示之后，该警示指出PPIs可能会干扰氯吡格雷的疗效，并且临床医生应该重新评估正在服用氯吡格雷的患者开始或继续使用PPI进行治疗的情况。然而，一些专家表达了他们的担忧，即鉴于所有提示该问题的临床研究都是观察性的，氯吡格雷与PPI的相互作用被赋予了过高的重要性。在这篇综述中，我们批判性地分析了现有数据，并就接受氯吡格雷治疗的患者合理使用PPIs向临床医生提出了实用建议。基于目前可得的证据，我们建议，对于正在服用氯吡格雷的患者，是否开具PPI的决定必须基于个体患者，权衡胃肠道风险与可能的血栓形成风险，并且PPIs仅应用于真正合适的适应症。
