Abrignani Maurizio Giuseppe, Lombardo Alberto, Braschi Annabella, Renda Nicolò, Abrignani Vincenzo
Operative Unit of Cardiology, P. Borsellino Hospital, ASP Trapani, Marsala 91025, Trapani, Italy.
Operative Unit of Cardiology, S. Antonio Abate Hospital, ASP Trapani, Erice 91100, Trapani, Italy.
World J Cardiol. 2023 Aug 26;15(8):375-394. doi: 10.4330/wjc.v15.i8.375.
Aspirin, other antiplatelet agents, and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases. A concomitant proton pump inhibitor (PPI) treatment is often prescribed in these patients, as gastrointestinal complications are relatively frequent. On the other hand, a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs; in particular, it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel, due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism. Previously, the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged. In contrast, it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel, new P2Y12 receptor antagonists. Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids, or non-steroidal anti-inflammatory drugs, and () infection. In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding, PPIs could be recommended, even if their usefulness deserves further data. infection should always be investigated and treated in patients with a history of peptic ulcer disease (with or without complication) treated with antithrombotic drugs. The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors, anticoagulants, and PPIs, discussing consequent clinical implications.
阿司匹林、其他抗血小板药物和抗凝药物被广泛应用于各种心血管和脑血管疾病。由于胃肠道并发症相对常见，这些患者常同时开具质子泵抑制剂（PPI）进行治疗。另一方面，有研究表明接受PPI治疗的患者心血管事件风险可能增加；特别是，由于通过肝脏代谢的药效学和药代动力学相互作用，这些药物是否会降低氯吡格雷的心血管保护作用一直存在讨论。此前，不建议同时使用氯吡格雷和奥美拉唑或埃索美拉唑。相比之下，PPI的使用是否会影响新型P2Y12受体拮抗剂替格瑞洛和普拉格雷的临床疗效仍鲜为人知。目前的指南建议，对于有胃肠道出血风险因素的患者，包括高龄、同时使用抗凝剂、类固醇或非甾体抗炎药以及（）感染，应将PPI与抗血小板治疗联合使用。对于有胃肠道出血风险因素的口服抗凝剂患者，即使其有效性还需要更多数据支持，也可推荐使用PPI。对于有消化性溃疡病史（无论有无并发症）且接受抗血栓药物治疗的患者，应始终对（）感染进行调查和治疗。本综述总结了目前关于血小板抑制剂、抗凝剂和PPI广泛联合使用的知识，并讨论了相应的临床意义。
