不同的质子泵抑制剂与氯吡格雷相互作用的研究进展

大量研究表明阿司匹林和氯吡格雷联合抗血小板可以降低急性冠状动脉综合征及冠状动脉支架植入术后复发心血管事件的概率。但由于联合抗血小板治疗会增加出血的风险,所以目前临床推荐加用质子泵抑制剂以预防胃肠道溃疡和出血。氯吡格雷和质子泵抑制剂均通过细胞色素P450同工酶系统代谢,质子泵抑制剂通过竞争性抑制细胞色素P450同工酶CYP2C19,而降低氯吡格雷的抗血小板活性,增加复发心血管事件的概率。最近的研究发现不同的质子泵抑制剂影响程度不同,泮托拉唑和埃索美拉唑对氯吡格雷作用影响较小,而奥美拉唑、雷贝拉唑和兰索拉唑对氯吡格雷的抗血小板活性抑制作用较大。

Progress in Interaction Between Clopidogrel and Proton Pump Inhibitors

Many studies have indicated that dual antiplatelet therapy with clopidogrel and aspirin can reduce recurrent cardiac events in patients with acute coronary syndromes,and those who have undergone coronary artery stent placement.Due to the increased risk of bleeding in patients on dual antiplatelet therapy,concomitant gastrointestinal ulcer and bleeding prophylaxis with a proton pump inhibitor is frequently prescribed.Both clopidogrel and proton pump inhibitors are transformed in vivo by the cytochrome P450 enzyme system.Due to the CYP2C19 inhibition by the prolon pump inhibitors,they may decrease the antiplatelet activity of clopidogrel and increase the recurrent cardiac events.Recent studies indicate that the degree of CYP2C19 inhibition by the proton pump inhibitors is different.Comparatively panto prazole,esomeprazole,omeprazole,rabeprazole and lansoprazole have significantly more influences on inhibiting the antiplatelet activity of clopidogrel.