质子泵抑制剂联用抗血小板药物研究进展

Progress on combined of proton pump inhibitors and anti-platelet drugs

加用氯吡格雷的双联抗血小板治疗目前已成为冠心病的常规治疗,然而临床抗血小板治疗会增加胃肠道出血风险,因此临床上常加用质子泵抑制剂(PPIs)来减少胃肠道不良反应。PPIs和氯吡格雷经相同的肝酶代谢,因此两者联用会产生代谢竞争。近期的研究分别从基础和临床角度对此现象进行分析,但并未得出确切的结论,部分研究支持两类药物合用,认为PPIs并未影响氯吡格雷的抗血小板活性效价,未增加临床事件风险;而另一部分研究则持相反意见,还有研究认为只有部分种类的PPIs会影响其抗血小板活性和增加心血管再发事件风险。因此在两类药物的临床应用上应评估PPIs使用的必要性,对需要加用PPIs者首选药物相互影响较小的PPIs。

Summary：Dual anti-platelet treat including clopidogrel has been the routine in the CHD treatment, however anti-platelet treat can increase gastrointestinal bleeding risk, so usually we add proton pump inhibitors （PPIs）to reduce this adverse reaction. PPIs and clopidogrel are metabolized through the same enzyme in liver, so combined use of the two can induce metabolic competition. Recent research have analyzed this phenomenon from basic and clinic point of view, but no exact conclusion were got, part research support combined use of two drugs that PPIs don＇t interact the anti-platelet effect of clopidogrel and don＇t increase risk of clinical events. But other research take the opposite point,there are also point.that only a few kinds of PPIs can interact the anti-platelet effect of clopidogrel and increase the risk of recurrent cardiovascular events. So on the use of two drugs the necessarity of use for PPIs should be evaluated,the PPIs that have little interaction with clopidogrel should be the first choice.