质子泵抑制剂对房颤患者达比加群水平的影响。
The Impact of Proton Pump Inhibition on Dabigatran Levels in Patients With Atrial Fibrillation.
机构信息
Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
BioMed Martin, Division of Molecular Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
出版信息
Am J Ther. 2019 May/Jun;26(3):e308-e313. doi: 10.1097/MJT.0000000000000599.
BACKGROUND
Proton pump inhibition (PPI) administrated together with dabigatran reduces the risk of gastrointestinal hemorrhage. However, there is a discussion regarding possible PPI-dabigatran interaction that may reduce the efficacy of this therapy.
STUDY QUESTION
To determine the impact of concomitant PPI on dabigatran plasma levels in patients with nonvalvular atrial fibrillation (NV-AF).
STUDY DESIGN
A pilot prospective study in patients with NV-AF on dabigatran therapy was performed; 31 patients were enrolled. PPI with either omeprazole or pantoprazole was administrated in 19 patients.
MEASURES AND OUTCOMES
Blood samples were taken for the assessment of the dabigatran trough and peak levels. Dabigatran concentration was measured with the Hemoclot Thrombin Inhibitor Assay.
RESULTS
There were significant differences in dabigatran trough level comparing patients treated with PPI and patients without PPI (58.86 ± 36.76 ng/mL vs. 110.72 ± 88.47 ng/mL, P < 0.05). Similarly, there were significant differences in dabigatran peak level between compared groups (88.0 ± 20.5 ng/mL vs. 174.4 ± 139.64 ng/mL, P < 0.05).
CONCLUSIONS
This pilot study demonstrated the interaction between PPI and dabigatran levels in patients with NV-AF.
背景
质子泵抑制剂（PPI）与达比加群联合使用可降低胃肠道出血的风险。然而，关于 PPI-达比加群相互作用可能降低这种治疗效果的讨论仍在继续。
研究问题
确定非瓣膜性心房颤动（NV-AF）患者同时使用 PPI 对达比加群血浆水平的影响。
研究设计
对接受达比加群治疗的 NV-AF 患者进行了一项前瞻性的初步研究；共纳入 31 例患者。19 例患者接受 PPI（奥美拉唑或泮托拉唑）治疗。
测量和结果
采集血样以评估达比加群的谷值和峰值水平。使用 Hemoclot 凝血酶抑制剂测定法测量达比加群的浓度。
结果
与未使用 PPI 的患者相比，使用 PPI 的患者的达比加群谷值水平有显著差异（58.86±36.76ng/mL 比 110.72±88.47ng/mL，P＜0.05）。同样，与未使用 PPI 的患者相比，使用 PPI 的患者的达比加群峰值水平也有显著差异（88.0±20.5ng/mL 比 174.4±139.64ng/mL，P＜0.05）。
结论
这项初步研究表明，PPI 与 NV-AF 患者的达比加群水平之间存在相互作用。
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