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加用氯吡格雷的双联抗血小板治疗目前已成为冠心病的常规治疗,然而临床抗血小板治疗会增加胃肠道出血风险,因此临床上常加用质子泵抑制剂(PPIs)来减少胃肠道不良反应。PPIs和氯吡格雷经相同的肝酶代谢,因此两者联用会产生代谢竞争。近期的研究分别从基础和临床角度对此现象进行分析,但并未得出确切的结论,部分研究支持两类药物合用,认为PPIs并未影响氯吡格雷的抗血小板活性效价,未增加临床事件风险;而另一部分研究则持相反意见,还有研究认为只有部分种类的PPIs会影响其抗血小板活性和增加心血管再发事件风险。因此在两类药物的临床应用上应评估PPIs使用的必要性,对需要加用PPIs者首选药物相互影响较小的PPIs。
Double antiplatelet therapy with clopidogrel has now become a routine treatment of coronary heart disease, however, clinical antiplatelet therapy can increase the risk of gastrointestinal bleeding, so often use proton pump inhibitors (PPIs) to reduce gastrointestinal Adverse reactions. PPIs and clopidogrel are metabolized by the same liver enzymes, so the combination of the two produces metabolic competition. Recent studies have analyzed this phenomenon from a basic and clinical perspective, respectively, but did not conclusively conclude that some studies support a combination of two classes of drugs, suggesting that PPIs did not affect antiplatelet activity titres of clopidogrel but did not increase clinical Event risk; while the other part of the study is contrary to opinion, there are studies that only some species of PPIs will affect its anti-platelet activity and increase the risk of cardiovascular events. Therefore, the clinical application of two types of drugs should be assessed on the necessity of PPIs, PPIs need to add the preferred drug interaction of smaller PPIs.