Magnus A. B. Axelsson, Naldy Parodi López, Eva Wikström Jonsson, Susanna M. Wallerstedt
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Regarding efficacy with or without a PPI, the pooled risk ratio (RR) and risk difference (RD) were 1.08 (95% confidence interval (CI) 0.78; 1.50) and 0.2 percentage points (95% CI −0.9; 1.2), respectively (four RCTs; 4341 patients [96% also used aspirin, 98% receiving I used (es)omeprazole]; moderate certainty evidence). Regarding safety, the RR and RD were 0.13 (95% CI 0.03; 0.59) and −0.7 percentage points (95% CI −1.1; −0.3), respectively (one RCT; 3761 patients; moderate certainty evidence). The available evidence did not allow conclusions regarding omeprazole versus pantoprazole. In conclusion, concurrent use of a PPI probably does not largely affect clopidogrel efficacy, but probably reduces the risk of overt gastrointestinal bleeding.</p>","PeriodicalId":8733,"journal":{"name":"Basic & Clinical Pharmacology & Toxicology","volume":"137 2","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bcpt.70087","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Clopidogrel With and Without a Proton Pump Inhibitor: A Systematic Review and Meta-Analysis\",\"authors\":\"Magnus A. B. Axelsson, Naldy Parodi López, Eva Wikström Jonsson, Susanna M. Wallerstedt\",\"doi\":\"10.1111/bcpt.70087\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Classifications of drug interaction alerts regarding clopidogrel and a proton pump inhibitor (PPI) differ between knowledge resources. 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Regarding safety, the RR and RD were 0.13 (95% CI 0.03; 0.59) and −0.7 percentage points (95% CI −1.1; −0.3), respectively (one RCT; 3761 patients; moderate certainty evidence). The available evidence did not allow conclusions regarding omeprazole versus pantoprazole. 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引用次数: 0
摘要
关于氯吡格雷和质子泵抑制剂(PPI)的药物相互作用警报的分类在不同的知识资源之间存在差异。本系统综述检索了Medline、Embase和Cochrane图书馆中适用PICO标准的随机对照试验(rct): P =服用氯吡格雷的患者;I =干预:PPI(亚组:奥美拉唑);C =比较:无PPI (C1)或除奥美拉唑(C2)以外的PPI;O =结局,主要:心血管事件的综合(疗效);另外:明显的胃肠道出血(安全)。14项rct符合PICO标准,5项无高偏倚风险,每个研究组至少有一个临床事件。关于是否使用PPI的疗效,合并风险比(RR)和风险差(RD)为1.08(95%置信区间(CI) 0.78;1.50)和0.2个百分点(95% CI−0.9;1.2)(4项随机对照试验;4341例患者[96%同时使用阿司匹林,98%同时使用奥美拉唑];中等确定性证据)。在安全性方面,RR和RD为0.13 (95% CI 0.03;0.59)和- 0.7个百分点(95% CI - 1.1;−0.3),分别为(1项RCT;3761例;中等确定性证据)。现有的证据并不能得出关于奥美拉唑和泮托拉唑的结论。总之,同时使用PPI可能不会很大程度上影响氯吡格雷的疗效,但可能会降低明显胃肠道出血的风险。
Efficacy and Safety of Clopidogrel With and Without a Proton Pump Inhibitor: A Systematic Review and Meta-Analysis
Classifications of drug interaction alerts regarding clopidogrel and a proton pump inhibitor (PPI) differ between knowledge resources. In this systematic review, Medline, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) applying PICO criteria: P = patients on clopidogrel; I = intervention: PPI (subgroup: [es]omeprazole); C = comparison: no PPI (C1) or a PPI other than (es)omeprazole (C2); O = outcomes, main: a composite of cardiovascular events (efficacy); also: overt gastrointestinal bleeding (safety). Fourteen RCTs fulfilled the PICO criteria, five without high risk of bias and with at least one clinical event per study arm. Regarding efficacy with or without a PPI, the pooled risk ratio (RR) and risk difference (RD) were 1.08 (95% confidence interval (CI) 0.78; 1.50) and 0.2 percentage points (95% CI −0.9; 1.2), respectively (four RCTs; 4341 patients [96% also used aspirin, 98% receiving I used (es)omeprazole]; moderate certainty evidence). Regarding safety, the RR and RD were 0.13 (95% CI 0.03; 0.59) and −0.7 percentage points (95% CI −1.1; −0.3), respectively (one RCT; 3761 patients; moderate certainty evidence). The available evidence did not allow conclusions regarding omeprazole versus pantoprazole. In conclusion, concurrent use of a PPI probably does not largely affect clopidogrel efficacy, but probably reduces the risk of overt gastrointestinal bleeding.
期刊介绍:
Basic & Clinical Pharmacology and Toxicology is an independent journal, publishing original scientific research in all fields of toxicology, basic and clinical pharmacology. This includes experimental animal pharmacology and toxicology and molecular (-genetic), biochemical and cellular pharmacology and toxicology. It also includes all aspects of clinical pharmacology: pharmacokinetics, pharmacodynamics, therapeutic drug monitoring, drug/drug interactions, pharmacogenetics/-genomics, pharmacoepidemiology, pharmacovigilance, pharmacoeconomics, randomized controlled clinical trials and rational pharmacotherapy. For all compounds used in the studies, the chemical constitution and composition should be known, also for natural compounds.