質子幫浦抑制劑與Clopidogrel併用安全性探討：實證醫學應用

Doubting the Safety of the Combination of a Proton Pump Inhibitor and Clopidogrel : Evidence-Based Results

冠狀動脈疾病患者在接受冠狀動脈介入性治療後，多會服用抗凝血劑，如： clopidogrel用於抑制血小板的凝集，避免栓塞再形成。近來有報導指出clopidogrel和proton pump inhibitor併用安全性疑慮。依循實證醫學步驟，找到三篇相關臨床研究文獻，分別指出clopidogrel與proton pump inhibitor併用會增加心血管疾病再住院風險和死亡率。此外，因藥物交互作用存在種族基因差異性，所以選用以Taiwan為主研究文獻，並且考量藥物經濟學及利用實證醫學的方法所歸納的結論：對於心肌梗塞做心導管支架後而正服用clopidogrel的患者，因proton pump inhibiotr和clopidogrel併用會產生藥物交互作用，導致clopidogrel抗凝血作用下降而造成心血管疾病再住院率和死亡率增加，建議選用histamine-2 receptor antagonists（除cimetidine以外）作為預防胃腸道出血副作用的藥物。

A coronary artery disease patient who receives percutaneous coronary intervention (PCI) generally takes an anticoagulant such as clopidogrel to inhibit platelet aggregation. Some recent reports have doubted the safety of the combination of clopidogrel and a proton pump inhibitor. Relying on evidence-based medicine, we searched the related clinical research literature and found three studies which showed that the combination of clopidogrel and a proton pump inhibitor increased the risk of rehospitalization and mortality from cardiovascular disease. We selected study literature from Taiwan because there are genotypic racial differences in drug interactions. Conclusions: Patients who receive PCI with a stent after myocardial infarction take clopidogrel. Because the concomitant use of clopidogrel and proton pump inhibitors will produce a drug interaction resulting in a reduction of the clopidogrel anticoagulant effect and an increase in the rate of rehospitalization and mortality from cardiovascular disease, we suggest that histamine-2 receptor antagonists (except cimetidine) be used as preventive medication for the potential side effect of gastro-intestinal tract hemorrhage.