- 期刊
合併使用抗血小板藥品與氫離子幫浦抑制劑之臨床考量
Clinical Reevaluation of Concomitant Usage of Anti-Platelet Agents and Proton Pump Inhibitors
摘要
抗血小板藥品可有效降低心血管疾病之風險，但也增加了腸胃道出血的機會。嚴重的腸胃道出血，可導致病人住院、甚至死亡，而迫使抗血小板藥品之治療中斷。因此，氫離子幫浦抑制劑（proton pump inhibitor，PPI）常與抗血小板藥品共同被處方，而PPI確可降低腸胃道之副作用。但是根據藥品動態學上的諸多證據，某些抗血小板藥品，如腺嘌呤核苷二磷酸受體拮抗劑（ADP receptor antagonists，又稱thienopyridines）和PPI有著密切的交互作用，繼而產生可能降低抗血小板藥品療效，甚至影響臨床預後的疑慮。即使如此，現有的臨床實證仍顯單薄，也不一致。本文回顧近年來之相關研究、證據及專家之共識，對此一議題做深入之探討。建議合併使用此類藥品時，應考量病患之病史及臨床特徵，經評估其益處及風險後，方能給予病患最適當的治療。
並列摘要
Anti-platelet agents are proved to be effective for primary and secondary prevention of cardiovascular event, but they will cause peptic ulcer disease with bleeding, leading to morbidity and mortality. Therefore, proton pump inhibitors are usually co-prescribed for preventing ulcer bleeding. However, a substantial of recent reports raises concerns on what drug-drug interaction of thienopyridine and proton pump inhibitors may translate into clinical outcomes based on pharmacokinetics evidences. Nevertheless, the effect of co-treatment of clopidogrel and a proton pump inhibitor on cardiovascular outcomes has been inconsistent and conflicting. A newly published clinical guideline provides some useful recommendations to deal with this challenging clinical situation.