氯吡格雷与PPI安全性问题介绍.pptx

;医学伦理学的基本原则;PPI与氯吡格雷的相互作用;PPI与氯吡格雷：理论上的“黄金搭档”;2009年：PPI与氯吡格雷风波;Conclusions: There was no apparent cardiovascular interaction between clopidogrel and omeprazole.;氯吡格雷;氯吡格雷的作用机制;PPI与氯吡格雷相互作用的药代动力学基础;;PPI代谢对CYP2C19的依赖程度不同;药物与氯吡格雷的相互作用：非PPI独有;在同时应用氯吡格雷患者中，不 需要改变PPI治疗，因为没有发现心血管风险升高;临床实践中的注意事项;联合应用的观点之一;联合应用观点之二;联合应用观点之三;;现有的专家共识;联合应用之药学观点;临床用药需考虑的因素;;快代谢型（EM）;CYP2C19基因多态性对PPI药代动力学影响(omeprazole、lansoprazole、rabeprazole);氯吡格雷的临床研究;2010年3月，美国FDA建议患者服用波立维前检测CYP2C19基因型。;ACCF/AHA专家共识（2010年6月28日） ;Antiplatelet drug interactions with proton pump Expert Opin Drug Metab Toxicol. 2013 Nov 9. [Epub ahead of print]] Proton pump inhibitors and clopidogrel: an association to avoid? Intern Emerg Med. 2013 Sep 13. [Epub ahead of print] Impact of the proton pump inhibitors and CYP2C19*2 polymorphism on platelet response to clopidogrel as assessed by four platelet function assays. Thromb Res. 2013 Aug;132(2):e105-11. doi: 10.1016/j.thromres.2013.06.015. Epub 2013 Jul 2. Proton pump inhibitors and potential interactions with clopidogrel: an update. Curr Gastroenterol Rep. 2013 Jun;15(6):329. doi: 10.1007/s11894-013-0329-1. Effect of the clopidogrel-proton pump inhibitor drug interaction on adverse cardiovascular events in patients with acute coronary syndrome. Pharmacotherapy. 2012 Sep;32(9):809-18. doi: 10.1002/j.1875-9114.2012.01112.x. Epub 2012 Jun 28. Differential inhibitory effects of proton pump inhibitors on the metabolism and antiplatelet activities of clopidogrel and prasugrel. Biopharm Drug Dispos. 2012 Jul;33(5):278-83. doi: 10.1002/bdd.1795. Epub 2012 Jun 29. Ability of rabeprazole to prevent gastric mucosal damage from clopidogrel and low doses of aspirin depends on CYP2C19 genotype.Clin Gastroenterol Hepatol. 2012 Aug;10(8):879-885.e2. doi: 10.1016/j.cgh.2012.04.016. Epub 2012 Apr 25. ;基于基因多态性的联合用药;PPI代谢对CYP2C19的依赖程度不同;“将来”的专家共识;循证医学时代：从理论到实践，证据是试金石;在同时应用氯吡格雷患者中，不 需要改变PPI治疗，因为没有发现心血管风险升高;临床实践中的注意事项;小 结;THANK YOU