終於,有人發出了正義之聲,PPI and plavix....

衛生署通常會在國外發一個preliminary report時,就原文照翻發公文…

藥政科就會迫不及待公文說某某有問題,用了就是你們沒看電視,就是沒醫德,有問題是你家的事,我公文發了就盡了告知之責,責任就是你家的。

健保局見獵心喜,跟進說這個是高價藥物,用了就是殘害病人身體……藥價黑洞

PPI plavix 爭議就是其中一個例子…… 沒差啦… 臨床上面CAD不屬於下面講的high risk group的人還真不多見耶…還是一句話,病人優先…

還有一個,CVP bundle 的 2% chlorhexidine,會不會重蹈xigris的覆轍?

Consensus Document on Concomitant Use of Clopidogrel and PPIs

Proton-pump inhibitors are endorsed for clopidogrel patients at high risk for gastrointestinal bleeding.

To address the somewhat confusing literature on the interaction between proton-pump inhibitors (PPIs) and clopidogrel, a new "consensus document" has been published jointly by the American College of Cardiology, American College of Gastroenterology, and American Heart Association.

Clopidogrel is converted to its active form by the hepatic enzyme CYP2C19, which is competitively inhibited by PPIs. Although platelet function studies have shown that PPI use lessens clopidogrel-mediated inhibition of platelet aggregation, the clinical relevance of this observation has been debated.

The consensus writers make the following points:

* Some, but not all, observational studies have shown small statistically significant higher risk for adverse cardiovascular events among patients who received PPIs and clopidogrel concomitantly (compared with clopidogrel alone). However, in the only large randomized trial (the recently published COGENT study; JW Cardiol Oct 6 2010), patients who received omeprazole plus clopidogrel had similar rates of adverse cardiovascular events and lower rates of adverse gastrointestinal (GI) events than recipients of clopidogrel alone.
* In patients with histories of upper GI bleeding and those at high risk for this complication (e.g., advanced age; concomitant use of warfarin, steroids, or nonsteroidal anti-inflammatory drugs; Helicobacter pylori infection), the benefits of PPI therapy probably outweigh the very small risk that PPI therapy will interfere with clopidogrel's efficacy.
* Patients at low risk for GI bleeding who require clopidogrel therapy should not receive concomitant PPIs.

Comment: This document will disappoint readers who expect an unambiguous algorithm that is easily applied to all patients. Nevertheless, by endorsing use of PPIs for clopidogrel-treated patients at high risk for upper GI bleeding, the authors provide validation for this widespread practice.

— Allan S. Brett, MD

Published in Journal Watch General Medicine December 9, 2010
Citation(s):

Abraham NS et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: A focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. J Am Coll Cardiol 2010 Dec 7; 56:2051. (http://dx.doi.org/10.1016/j.jacc.2010.09.010)

* Original article (Subscription may be required)
* Medline abstract (Free)

https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7MjU5Mjc0NTUtZmI2Zi00YjgwLWFlNjgtMWI5NTgxYWMxOGM5&hl=zh_TW




http://jfliu-chestman.blogspot.com/2010/06/plavix-ppi-again-rctcogent-study.html

http://jfliu-chestman.blogspot.com/2010/06/ppi-plavix-mi-93.html

留言

這個網誌中的熱門文章

即便是用IGRA, 有時也要等大於三個月才能決定TB contact

每天吃約70公克的nuts -> oh my god -> LDL會好看一點 -> 但可以推到improved outcome?

CLABSI 在美國降低