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首页> 外文期刊>Current opinion in gastroenterology >Prescribing proton pump inhibitor and clopidogrel together: current state of recommendations.
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Prescribing proton pump inhibitor and clopidogrel together: current state of recommendations.

机译：一起处方质子泵抑制剂和氯吡格雷：目前的建议状态。

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摘要

PURPOSE OF REVIEW: Conflicting evidence has contributed to confusion regarding the safety of co-prescribing a proton pump inhibitor (PPI) and clopidogrel. This review will quantify the risk of gastrointestinal bleeding associated with common cardioprophylactic regimens, review the evidence regarding a PPI-clopidogrel interaction and assess its clinical relevance, and reinforce best-practice recommendations for gastrointestinal bleeding prevention among patients prescribed clopidogrel. RECENT FINDINGS: The COGENT trial confirmed a substantial reduction in gastrointestinal bleeding risk without apparent increase in cardiovascular events when clopidogrel was co-prescribed with omeprazole. These data are consistent with secondary data analyses of large cardiovascular trials and well adjusted observational studies that also failed to confirm a consistent, clinically relevant increase in cardiovascular endpoints or mortality. Individual genetic variations in drug metabolism may contribute to increased cardiac event rates observed in small subsets of the population when PPI is co-prescribed. In the future, pharmacogenomics and point-of-care testing will likely play an emerging role in individualizing prescription strategy. SUMMARY: A pragmatic approach dictates an explicit risk-benefit assessment prior to co-prescription to maximize cardiac benefit and minimize the risk of gastrointestinal bleeding.
机译：审查目的：矛盾的证据促使人们对共同处方质子泵抑制剂（PPI）和氯吡格雷的安全性感到困惑。这篇综述将量化与常规心脏预防方案相关的胃肠道出血的风险，回顾有关PPI-氯吡格雷相互作用的证据并评估其临床相关性，并加强处方氯吡格雷患者预防胃肠道出血的最佳实践建议。最新发现：当氯吡格雷与奥美拉唑合用时，COGENT试验证实胃肠道出血风险显着降低，而心血管事件没有明显增加。这些数据与大型心血管试验的次要数据分析和经过良好调整的观察性研究一致，这些研究也未能证实心血管终点或死亡率的持续，临床相关增加。当共同开具PPI时，药物代谢中的个体遗传变异可能会导致在人群的一小部分中观察到的心脏事件发生率增加。将来，药物基因组学和即时检验将可能在个性化处方策略中发挥新兴作用。摘要：务实的方法要求在共同处方之前进行明确的风险-获益评估，以最大程度地提高心脏获益并最大程度地减少胃肠道出血的风险。

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