Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view  

作　　者：Maurizio Giuseppe Abrignani Alberto Lombardo Annabella Braschi Nicolo Renda Vincenzo Abrignani 

机构地区：[1]Operative Unit of Cardiology,P.Borsellino Hospital,ASP Trapani,Marsala 91025,Trapani,Italy [2]Operative Unit of Cardiology,S.Antonio Abate Hospital,ASP Trapani,Erice 91100,Trapani,Italy [3]Department of Psychology,Educational Science and Human Movement,University of Palermo,Palermo 90100,Italy [4]Department of Direction,CTA Salus,Gibellina 91024,Trapani,Italy [5]Operative Unit of Internal Medicine with Stroke Care,Department of Health Promotion,Mother and Child Care,Internal Medicine and Medical Specialties(ProMISE)“G.D’Alessandro”,University of Palermo,Palermo 90100,Italy

出　　处：《World Journal of Cardiology》2023年第8期375-394,共20页世界心脏病学杂志（英文版）（电子版）

摘　　要：Aspirin,other antiplatelet agents,and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases.A concomitant proton pump inhibitor(PPI)treatment is often prescribed in these patients,as gastrointestinal complications are relatively frequent.On the other hand,a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs;in particular,it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel,due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism.Previously,the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged.In contrast,it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel,new P2Y12 receptor antagonists.Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding,including advanced age,concurrent use of anticoagulants,steroids,or non-steroidal anti-inflammatory drugs,and Helicobacter pylori(H.pylori)infection.In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding,PPIs could be recommended,even if their usefulness deserves further data.H.pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease(with or without complication)treated with antithrombotic drugs.The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors,anticoagulants,and PPIs,discussing consequent clinical implications.

关 键 词：Antithrombotic drugs ANTICOAGULANTS ASPIRIN CLOPIDOGREL Gastrointestinal bleeding Proton pump inhibitors 

分 类 号：R541.75[医药卫生—心血管疾病]