Departments of Gastroenterology; and.
Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic; and.
J Cardiovasc Pharmacol. 2020 Apr;75(4):333-335. doi: 10.1097/FJC.0000000000000791.
Several studies demonstrated that proton pump inhibitors (PPIs) co-administrated with dabigatran in patients with atrial fibrillation (AF) decreased dabigatran trough and peak plasma levels. However, it is still unknown whether this interaction is reversible or not, and whether the withdrawal of PPI would lead to normalization of dabigatran plasma levels.
The aim of this study was to determine the effect of PPI withdrawal on dabigatran plasma levels in patients with AF.
This pilot prospective study enrolled 23 AF patients on long-term dabigatran and PPI therapy (omeprazole 20 mg twice daily or pantoprazole 40 mg once daily). Dabigatran trough and peak levels (ng/mL) were tested on PPI and after a 2-week period of PPI withdrawal with Hemoclot Thrombin Inhibitor Assay.
The analysis of dabigatran plasma levels demonstrated significant elevation in trough dabigatran levels after 2 weeks of PPI withdrawal (97.2 ± 79.7 vs. 163.8 ± 105.5 ng/mL; P < 0.05). Moreover, significantly higher peak dabigatran levels were observed after 2 weeks of PPI withdrawal (142.4 ± 102.8 vs. 255 ± 129.5 ng/mL; P ≤ 0.001).
This study showed that a 2-week period of PPI withdrawal lead to a significant increase in dabigatran trough and peak plasma levels in patients with AF.
几项研究表明，质子泵抑制剂 (PPI) 与房颤 (AF) 患者同时使用达比加群会降低达比加群的谷值和峰值血浆水平。然而，目前尚不清楚这种相互作用是否可逆，以及停用 PPI 是否会导致达比加群的血浆水平恢复正常。
本研究旨在确定 AF 患者停用 PPI 对达比加群血浆水平的影响。
这项前瞻性研究纳入了 23 例长期接受达比加群和 PPI（奥美拉唑 20mg，每日两次或泮托拉唑 40mg，每日一次）治疗的 AF 患者。用 Hemoclot 凝血酶抑制剂检测法检测 PPI 时和停用 PPI 2 周后的达比加群谷值和峰值（ng/mL）。
达比加群血浆水平分析显示，停用 PPI 2 周后达比加群的谷值水平显著升高（97.2±79.7 比 163.8±105.5ng/mL；P<0.05）。此外，停用 PPI 2 周后，达比加群的峰值水平显著升高（142.4±102.8 比 255±129.5ng/mL；P≤0.001）。
本研究表明，停用 PPI 2 周可导致 AF 患者达比加群的谷值和峰值血浆水平显著升高。
