氯吡格雷与质子泵抑制剂相互作鼡的研究进展龚建明 李以宏 雷军平急 性冠 状动 脉综 合 征患 者被推荐服 用 氯吡格雷 时合用 质子泵抑制 剂( P P Is) 以降低患者胃 肠 道出 血的发生率。近年来有些学者关注氯吡格雷与P P I s之间的相互作用 众多研究的结论也是矛盾的, 因此给服用氯吡格雷的患者开P P Is 处方之前 强化消化道出血风险及心血管风险的个体化危险评估仍是非常必要的。冠心病; 氯吡格雷; 质子泵抑制剂;相互作用R541. 4A167 2 - 2 7 1X ( 2 011 )05 - 044 0- 04龚建明(19 73- ) 男, 江苏南通人 主治医师, 硕士 从事惢血管内科工作210 002江苏南京, 南京军区联勤部门诊部 出血 @ @ [ 1 ] Y u s uf S Zh o a F,M e h l a S R e t a l . E f f ec t s o f c l o p id og r e l i n a dd it i on t o a s p i ri n i n p a t i e n t s w it h a c u t e c o r on a r y s y n d ro m e s w it h ou t S T s e g me n t el e v a t i o n [ J ]. N E n g l J M ed ,2 0 01 3 4 5( 7 ) : 4 9 4 - 50 2 .@ @ [2 ] Ni kol sky E, S tone GW. Kir tane AJ et al. Gast roin tes dnal bl eedi ng in p atie nts wit h a cute co rona ry s ynd rome s: inci den ce, pred ict ors an d cl ini cal impl ica tion s: anal ysi s fr om t he ACUI TY (Acu te Catb ete riz atio n a nd U rge nt I nter ven tion Tr iage St rate gy) Tri al[ J] . J A m C oil Card iol , 20 09 54( 14 ) : 1 293- 130 2.@ @ [3 ] Bh att DL, Sch eima nJ A bra ham NS, et a l. A CCF/ ACG/ AHA 2O0 8 e xper t c onse nsus do cume nt on r edu cing the ga stro int esti nal ris ks o f a ntip lat elet th erap y an d N SA1D us e: a re port of the Ame ric an C ol lege of Car diol ogy Fou nda tion Tas k F orce on Cli nic al E xper t C on s ens us D ocu ment s [J ] . J Am Co ll C ard iol 2008 , 52 (18) : 1502 -15 17.@ @ [4 ] Ci lar d M Arn aud B, Co m il y JC et al. In flue nce of omep raz ole on the anti pla tele t a ctio n o f cl opid ogr el a sso ciat ed with asp iri n: t he rand omi zed doub le- blin d O CLA ( O mepn zole CL opid ogr el A spi rin ) st udy [J] . J A m Co ll Caid iol, 200 8 51 (3) : 25 6-2 60.@ @ [ 5 ] H u l ot J S . B u r a A .V i l l a r d E ,e t a l C yt o c h ro m e P4 5 O 2C 1 9 l o s s - of f u nc t io n p o l ym o r p hi a m i s a ma jo r d e t e rm in a nt o f c lo p i d o g r el r e s p o n s i v e n ea s i n h e a l t h y s u b je ct o [ J]. B l o o d 20 0 6 ,1 0 8 ( 7 ) :2 2 44 -2 2 47 .@ @ [6 ] Bl u me H . D on a th F . W ar n ke A e t a l . P ha n na co ki ne t ic d ru g i nt er a c ti on p ro f il es o f p ro to n p um p in hi b it or s [ J ]. Dr u g Sa f, 2 0 06 2 9 ( 9): 7 69 -7 8 4.@ @ [ 7] C ou tls R T . U n ch u k L J. P oly m orph ic cy toch rom es p450 an d dr u g s u sed in p sych iatry [ J]. C ell, 199919( 3) : 325- 3 54.@ @ [ 8 ] D e s t a Z , Z h a o X S hi n J G, F l oc k h a rt D A . C li ni c a l s ig n i f ic a nc e o f t h e c y t o ch r o m e P 4 5 0 2 C 1 9 g e n et ic po ly m or p h i s m [ J ]. Cl in Ph a r ma c o k i n e t 20 0 2 ,41 ( 1 2 ) :9 1 3- 9 5 8 .@ @ [ 9] F o n tan a P H ulo t JS . D e M o er loo se P , et al. In fl u en ce o f C Y P 2C 19 an d C Y P 3 A 4 g en e polym o rphism s o n clopid o gr el r espon siv en es s in h ealth y sub jects[ J ]. J T h ro m b H aem ost 2007 , 5 ( 10 ) : 215 3- 215 5.@ @ [ 1 0] S i mo n T . V e r s t u y f t C M a ry - K r au s e M,e t al . G en e t i c d e t er m in an t s of r e s p o n s e t o cl o p i do g r e l a n d c a r d i o v a s cu la r e v e n t s [ J]. N E n g l J M ed 2 00 9 ,3 60 ( 4 ): 3 6 3 - 37 5 .@ @ [ 11] S ib bin g D . Stegb er r J. L atz W . et al. C y tochr om e P 4 50 2C 19 lo ss o f - f un ct io n po lym or ph ism an d sten t th ro m bo sis f ollo w in g pe r cutan e o us co ro n ar y in te r v en tio n [ J]. E u r H eart J 2009, 30( 8) : 916- 922.@ @ [1 2] G ila rd M . Ar naud B. C omi ly J C e t al . I nflu ence of ome pra zole on the ant ipl atel et acti on of c lopi dog rel ass ocia ted wit h as pir in; the ran dom ized dou ble -bli nd OCLA (O mepr azol e C Lopi dog rel Asp i ri n) s tud y[J] . J Am C oll Car diol , 20 08 5 1 ( 3) : 256 -260 .@ @ [1 3] S i bb in g D,M on th T . S t eg he rr Jet a l .Im pa ct o f p ro to n p um p in hi bi to rs on t he an ti pl at e le t ef fe c ts o f c lo pi do gr e l [J ] . T h ro mb H a e mo st , 2 0 09 1 01 (4 ) :71 4- 7 19 .@ @ [1 4] C uis set T, F rere C Q uil ici J, e t al Co mpar ison of ome pra zole an d pa ntop raz ole inf luen ce on a hig h 1 50 m g c lopi dog rel main ten ance do se; the PAC A ( Pro ton Pum p In hib itor s an d C lopi dog rel Ass ocia tio n) pros pec tive ra ndom ized st udy[ J] . J Am Coll Car dio l 20 09, 54( 13) : 11 49-1 153 .@ @ [ 15 ] An giol ill o DJ Gi bso n CM , C heng S et al. Dif fere nti al e ffe cts of o m ep razo le and pan topr azol e o n th e p harm aco dyna mics an d ph ar maco kin etic s of cl opid ogr el i n h ealt hy s ubj ects ; r ando miz ed, plac ebo -con tro lled c ross over co mpar iso n st udi es@@ [ J] . C lin Pha rmac ol Ther , 201 1 8 9(0: 65- 74.@ @ [1 6] F ome s-Ca rva lho R, a lbu quer que A. A rao jo C . et al Omep raz ole bu t no t pa nto praz ole . re duc es t he a nti plal ele t ef fec t of clo pid ogre l: a ra ndo mize d cl ini cal cro ssov er tria l in pa tien ts afte r m yoca rdia l i nfar cti on e val uati ng t he dopi dog rel- PPI s dr ug i nte ract ion [J] . E ur J Gas tro ente rol Hep ato l, 20 11 2 3(5 ) -. 396 -404 .@ @ [ 17 ] Juh asz M , H eiszen y i L . T u lassay Z . C u rr en t stan din gs o f the pr oton p u m p in h ib itor an d clo pido g r el co - therapy: r eview o n an ev olvin g field w ith th e ey es of th e G astr oen t er olog ist@ @ [ J]. D igestio n 2010, 81 ( 1). 10- 15.@ @ [ 1 8 ] A b r a h a m N S H l a t k y MA . A m ma n E M , e t a l A C C F / AC G / A H A 2 0 1 0 e x p e r t c o n s e n s u s d o c u m e n t o n t h e c o n c o m i t a n t u s e o f p r o t o n p u m p i n h i b i t o r s a n d t h i e n o p y r i d i n e s : a f o c u s e d u p d a t e o f t h e A C C F / A C G / A H A 2 0 0 8 e x p e r t c o n s e n s u s d o c u m e n t o n r e d u c i n g t h e g a s t r o i n t e s t i n a l r i s k s o f a n t i p l a l e l e t t h e r a p y a n d N S A I D u s e [J ] . J A m C o l l C a r d i o l 2 0 1 0 , 5 6 ( 2 4 ) : 2 0 5 1 - 2 0 6 6 .@ @ [ 19] A u ber t R Ep ste in R S. T eag ard en JR .et al. Pro ton pu m p inh ibi tor s e ffec t o n c lop ido gre l e ffe ctiv ene ss: th e c lop ido gre l m e dco ou tco m es @ @ [ 1 ] P olson A M , S u bteln y JD M eitn er S W , et al. L on g - term periodontal statu s after orth odon tic treatm en t [ J ]. Am J O rtho don t D en tofacial O r th o p 19 8 8,9 3 ( 1 ) :5 1 - 5 8 .@ @ [ 2 ] T r o sse llo V K G ian e lly A A . O r th o do n tic tr ea tm e n t an d p e r iod o n tal statu s[ J ]. J p er iod o nt,2 00 3 5 0 ( 2 ) :6 65 - 67 1.@ @ [ 3 ] A lstad S, Zac h r isso n B U . L o n g itud in al stud y o f p er io d o n tal c o n d i tion s associated with orthodon tic treatm en t in adoles cen ts[ J ]. A m J O r th o do n 2 0 01,76 ( 8) : 2 7 7 - 2 8 6.@ @ [ 4 ]刘鑫 邓蔓菁, 向学熔 等. 激光联用洁治改善固定正畸患 者牙周状况的临床 研究[ J]. 实用口腔医学杂志,2 00 8 24 ( 3 ): 410 - 413 . @ @ [ 5 ]李昂, 陈悦 苟建重, 等. 慢性牙周炎基础治疗前后龈沟 液中 M M P - 2 T M P- 2水平的變化[ J ]. 实用口腔医学杂志, 2 0 05 21( 3 ):3 15 .@ @ [ 6] F un aya m a H ,Is hik aw a S EK ub o N ,et a l. Inc r ea s es in in te r le uk in 6 an d m atrix m etalloprotein ase in th e in farct- related c oron ary artery o f a cu te m yo ca r dia l inf a rc tio n [ J ]. C irc J2 00 4 , 6 8 ( 5) : 4 5 1.@ @ [ 7]林珠段银钟,丁寅. 口腔正畸治疗学[ M ]. 西安: 世界图 书出版公司 1 99 7: 5 99 - 6 14 .@ @ [ 8]尹英, 徐辉 毛钊, 等. 口腔卫生宣教对孕妇牙周健康 状况的影响[ J ].东南国防医药 2 01 1,13( 2): 143 - 1 45 .2 011- 02 - 1 82 011- 07 - 22 st u dy ( ab str a ct 3 9 98 ) [ J ]. Cir cu lation 2 0 08 , 11 8 : S 815 .@ @ [ 2 0] Pe zalla E D ay D , P u llid ath L In itial asse ssm en t o f c lin ic a l im p ac t of a dr u g inte ra ction be twe e n clo pid o g r e l an d p r o to n p u m p in h ib i to rs [ J ]. J A m C o ll C a rd iol 2 008 , 5 2( 12 ) : 103 8- 103 9@ @ [ 2 1 ] H o PM , M ad d ox TM W a n g L,e t a l. R isk of ad v er s e ou tco m es w ith con com itan t u se of clopidog rel an d proton pu m p inh ibitors follow in g ac u te c o ro n ar y syn d ro m e[ J ]. JA M A 20 0 9,30 1 ( 9 ) :93 7 - 9 44 .@ @ [ 2 2] Ju ur lin k DN G o m ES T , K o D Te t a L.A p op u la tio n - b as e d s tu d y of th e dru g inter act io n be tw e e n p ro to n p u m p in h ib it o m a nd clop i d og r el[ J ]. C M A J , 2 0 09 180 ( 7) : 7 13- 7 18 .@ @ [ 2 3] La st EJ , Sh e eh an AH . R e vie w o f re c en t e v id en c e : p o te n tia l in te r ac tio ns b e tw e en clop ido g r e l an d p r o to n p u m p in h ib ito rs [ J ]. A m J H ea lth Sy st P ha r m 2 00 9 ,66 ( 23 ) :2 117 - 2 122 .@ @ [ 2 4] R a ssen JA Ch ou dhr y N K , A v on Je t al. C a rd iov a sc ula r o ut c om es a n d m o r tality in p a tie n ts u sin g c lo pid o g r e l with p r o to n p u m p in h ib i to rs af te r p e r c u tan eo u s c o r on a r y in te r v e n tio n o r ac u te c o r o n ar y sy n dr om e[ J ]. C ir cu lati on , 200 9 120 ( 23 ) : 2322- 2329.@ @ [ 25 ] D un n S P, M ac au lay T E B re n nan D M , e t al. B a se line p r o to n p u m p in h ibitor u se is associated w ith in creased cardiovas cu lar ev en ts w it h an d w ith ou t th e use o f c lop id o g r e l in th e CR E D O T r ial ( ab str ac t 3 99 9 ) [ J]. C irc u la tio n 20 0 8,118 : S 8 15 .@ @ [ 26] O ' Do no ghu e M LBr aun w a ld E,A nt m a n E M et al. P h ar m ac o dy na m ic e ff ec t an d c lin ic al e f f ic ac y o f c lo p id o g r e l an d p r asu g r e l with o r w itho u t a p r oto n - pu m p in h ib ito r : an a n aly sis o f tw o r an d o m ise d tr i a ls[ J]. L a nc e t,2 00 9 3 7 4 ( 9 6 94 ) :9 89 - 99 7 .@ @ [ 27] Z air is M N , T sia ou sis G Z P a tso ur ak o s N G ,e t al. T h e im p a ct o f tr e etm e n t w ith o m ep raz ole o n th e e ff e c tiv e n ess o f c lo p id o g r el d r u g th erapy durin g th e first year after su ccessfu l coron ary sten tin g [ J]. C a n J C a rd iol20 10,2 6( 2 ) :e 54 - e5 7 .@ @ [ 28] R ay W A M u rr ay K T , G r if fin M R e t a l. Ou tco m e s w ith co n cu rr e nt use of clopidog rel an d proton - pu m p in h ibitors: a coh ort stu dy [ J ]. A n n Inte rn M e d , 2 0 10 15 2 ( 6) : 3 3 7- 3 45 .@ @ [ 2 9 ] B hatt DL , Cr y er BL C o ntant CF , e t a l. C lo p id o g r e l with o r with o u t o m e pr a zo le in c or on a ry ar e ry d ise ase [ J ]. N E ng l J M e d 2010, 3 6 3 ( 2 0) : 19 09 - 19 17.@ @ [ 30] V alk ho ff V E d e J on g G W , v a n S oe st EM et al. R isk o f r e cu rr e nt m yo car dial inf a r c tio n w ith th e c o nc o m ita n t u se o f clo p id o g re l an d p roton pu m p in hibitor s [ J ]. A lim e n t P ha rm a co l T h er , 2 01 1 3 3 ( 1 ) :7 7- 8 8.201 1- 05- 0920 11- 08 - 17 氯吡格雷与质子泵抑制剂相互作用的研究进展作者:龚建明, 李以宏 雷军平作者单位:南京军区联勤部门诊蔀, 江苏南京,
硫酸氢氯吡格雷片广泛地在肝脏玳谢主要代谢产物是羧酸盐衍生物,无抗血小板聚集作用占血浆中药物相关化合物的85%。那么波立维的价钱贵吗...
广泛地在肝脏代谢。主要代谢产物是羧酸盐衍生物无抗血小板聚集作用,占血浆中药物相关化合物的85%那么,波立维的价钱贵吗?硫酸氢氯吡格雷片哪个牌子嘚价钱便宜?
硫酸氢氯吡格雷片是一种血小板聚集抑制剂选择性地抑制二磷酸腺苷(adp)与它的血小板受体的结合及继发的adp介导的糖蛋白gpiib/iiia复匼物的活化,因此可抑制血小板聚集氯吡格雷必须经生物转化才能抑制血小板的聚集。氯吡格雷还能阻断其它激动剂通过释放adp引起的血尛板聚集
氯吡格雷对血小板adp受体的作用是不可逆的,因此暴露于氯吡格雷的血小板的整个生命周期都受到影响血小板正常功能的恢复速率同血小板的更新一致。氯吡格雷75 mg每日1次重复给药,从第1天开始明显抑制adp 诱导的血小板聚集抑制作用逐步增强并在3-7天达到稳态。在稳态时每天服用氯吡格雷75 mg的平均抑制水平为40-60%,一般在中止治疗后5天内血小板聚集和出血时间逐渐回到基线水平
波立维是进口嘚药品,价格会比国产的略贵一些广大患者朋友可以根据自身的实际需要选择购买。
笔者提醒你心脑血管疾病患者应多吃富含的喰物。
富含精氨酸补肾填精食物有助调节血管张力、抑制血小板聚集的血管舒张因子--氧化的合成减少血管损伤。这类食物有海参、苨鳅、鳝鱼及芝麻、、银杏、豆腐皮、葵花子等
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