质子泵抑制剂联用瑞巴派特预防双联抗血小板治疗致胃黏膜损伤的合理性

Rationality of proton pump inhibitors combined with rebamipide in preventing DAPT-related gastric mucosal injury

双联抗血小板治疗(DAPT)诱发的胃黏膜损伤在心血管冠脉再通抗凝治疗中较为常见。质子泵抑制剂(PPIs)是临床上预防DAPT引起相关胃黏膜损伤的首选药物,胃黏膜保护药瑞巴派特也用于预防NSAIDs或长期小剂量应用阿司匹林引起的胃肠道出血。由于PPIs长期使用的局限性及其作为心血管事件的独立危险因素,在DAPT诱导胃肠出血的高危时期可联合使用PPIs与瑞巴派特或者使用PPIs的替代性药物沃诺拉赞,序贯使用瑞巴派特或间断应用PPIs,对PPIs不耐受者可换用H_(2)RAs。尚无指南指出,接受DAPT引起消化道出血风险高的患者,应预防性使用PPIs联合瑞巴派特进行护胃抑酸治疗。本文就两药联用预防DAPT引起相关胃黏膜损伤的合理性进行阐述,希望为临床预防DAPT引起胃肠出血的用药选择提供参考。

Dual antiplatelet therapy(DAPT)-induced gastric mucosal injury is more common in cardiovascular coronary recanalization.Proton pump inhibitors are the first choices to prevent DAPT-induced gastric mucosal injury,and the gastric mucosal protection drug-rebamipide is also used to prevent gastrointestinal bleeding caused by NSAIDs or long-term low-dose aspirin.Nevertheless,due to the limitations of long-term use of PPIs and its independent risk factors for cardiovascular events,the use of PPIs in combination with rebamipide or the use of PPIs alternative drug vonorazan at high-risk stage of DAPT-induced gastrointestinal bleeding is the main choice,sequentially using rebamipide or intermittently using PPIs,or using H_(2)RAs instead for people.There is no guideline that patients with high risk of gastrointestinal bleeding caused by DAPT should be treated with prophylactic PPIs combined with rebamipide for gastric acid suppression.This review briefly describes the rationality of PPIs combined with rebamipide in preventing DAPT-related gastric mucosal injury,which is aimed to provide a reference for selecting drugs for clinical prevention of DAPT-induced gastrointestinal bleeding.