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KMID : 0931320100100020045
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대한상부위장관.헬리코박터학회지
2010 Volume.10 No. 2 p.45 ~ p.48
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Proton Pump Inhibitor and Clopidogrel Interaction: Still Possibility or Now Fact?
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Oh Tae-Hoon
Jung Hwoon-Yong
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Abstract
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Clopidogrel is one of the most commonly prescribed medications worldwide to prevent recurrent cardiovascular (CV) events. Current American Heart Association guidelines recommend that patients prescribed clopidogrel plus aspirin should receive a proton pump inhibitor (PPI) to reduce gastrointestinal (GI) bleeding. However, lots of concerns have been raised about the potential for PPIs to decrease the efficacy of clopidogrel by inhibiting conversion to its active metabolite by cytochrome P450 enzymes. Some observational studies show that clopidogrel users prescribed PPIs have increased risks of CV events. Recently FDA discouraged the concomitant use of PPIs and clopidogrel to avoid drug interaction. However, current evidence does not justify a conclusion that PPIs are associated with CV events among clopidogrel users. Indeed propensity-matched and randomized trial showed no association with adverse CV outcome. In conclusion, as there are conflicting and inconsistent data regarding the adverse clopidogrel and PPI interaction, clinicians should pay attention to the potential risk of adverse CV outcome and benefit of decreasing GI bleeding before deciding to discontinue PPIs in patients taking clopidogrel
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KEYWORD
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Proton pump inhibitor, Clopidogrel, Interaction
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