Prescribing proton pump inhibitor and clopidogrel together: current state of recommendations

被引:13
作者
Abraham, Neena S. [1 ,2 ,3 ]
机构
[1] Michael E DeBakey VAMC, Gastroenterol Sect, Houston, TX 77030 USA
[2] Michael E DeBakey VAMC, Sect Hlth Serv Res, Houston, TX 77030 USA
[3] Baylor Coll Med, Dept Med, Houston, TX 77030 USA
关键词
antiplatelets; cardiac patients; clinical practice recommendations; consensus statement documents; gastrointestinal bleeding risk prevention; proton pump inhibitors; thienopyridine; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; PERCUTANEOUS CORONARY INTERVENTION; EXPERT CONSENSUS DOCUMENT; FOUNDATION TASK-FORCE; ANTIPLATELET THERAPY; CARDIOVASCULAR EVENTS; RISK-FACTORS; GASTROINTESTINAL RISKS; HELICOBACTER-PYLORI; CONCOMITANT USE;
D O I
10.1097/MOG.0b013e32834a382e
中图分类号
R57 [消化系及腹部疾病];
学科分类号
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.
引用
收藏
页码:558 / 564
页数:7
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