又一篇Plavix加PPI

Using Clopidogrel with a Proton-Pump Inhibitor
Risks for rehospitalization for myocardial infarction or stent placement were higher with combined therapy.

Studies have suggested that clopidogrel's efficacy is weakened if it is used in combination with a proton-pump inhibitor (PPI), given that the drugs compete for CYP2C19 activity. However, earlier retrospective studies might not have fully accounted for the likelihood that patients who receive PPIs are at higher baseline risk for cardiovascular events than are those who do not.

In this retrospective cohort study, based on U.S. claims data, researchers assessed risks for rehospitalization for myocardial infarction (MI) or stent placement among 2066 patients (mean age, 69) who were discharged from hospitals after MI or coronary stent placement; half the patients received clopidogrel alone, and half received it in combination with a PPI. Propensity scores were used to match patients by baseline cardiovascular risk. During 1 year of follow-up, combined-therapy recipients were more likely than clopidogrel-alone recipients to be rehospitalized for MI or coronary stent procedures (27.6 vs. 14.3 events per 100 person-years) or to be rehospitalized for MI (9.7 vs. 4.1 events per 100 person-years).

Comment:

Once again, PPIs have been shown to lower the efficacy of clopidogrel. Of note, a few studies have suggested that pantoprazole inhibits CYP2C19 less than other PPIs do and that it does not impair clopidogrel efficacy. In this study, pantoprazole had adverse effects that were similar to those of other PPIs. Discouraging use of PPIs in conjunction with clopidogrel seems prudent.

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Jamaluddin Moloo, MD, MPH

Published in Journal Watch General Medicine June 8, 2010

Citation(s):
Stockl KM et al. Risk of rehospitalization for patients using clopidogrel with a proton pump inhibitor. Arch Intern Med 2010 Apr 26; 170:704. (http://dx.doi.org/10.1001/archinternmed.2010.34)