质子泵抑制剂对华法林抗凝效果影响的研究进展

临床联用华法林与质子泵抑制剂的情况很多，鉴于华法林的治疗窗较窄，联用是否会影响华法林抗凝作用和增加出血风险，目前尚无定论。本文通过整合和分析国内外相关临床研究的证据，探讨各种质子泵抑制剂与华法林相互作用的机制和细胞色素P450（cytochrome P450）的CYP2C19基因多态性对两者相互作用的影响，发现华法林与泮托拉唑、雷贝拉唑联用相对较安全，但各研究对兰索拉唑、奥美拉唑、埃索美拉唑与华法林的相互作用是否具有临床意义仍存在争议，亟须进行前瞻性的多中心、随机、双盲、对照研究。

Development of the Impact on Anticoagulation Effect of Warfarin by Proton Pump Inhibitors

Warfarin is often combined with a proton pump inhibitor in clinical application. While considering the narrow therapeutic window of warfarin, whether the combination will affect the anticoagulant effect of warfarin and increase the risk of bleeding, the current studies on this are inconclusive. By integrating and analyzing related clinical researches at home and abroad, exploring the mechanism of interaction between proton pump inhibitors and warfarin and the influence of cytochrome P450 (CYP) CYP2C19 gene polymorphism on the interaction, we found that the combination of warfarin with pantoprazole or rabeprazole is relatively safe, but the clinical significance of interactions between warfarin and lansoprazole, omeprazole and esomeprazole remain controversial. So multicenter, randomized, double-blind and controlled prospective studies are in urgent need.