Koroner Yoğun Bakımda Yatan Akut Koroner Sendrom Hastalarında Tienopiridin ve Proton Pompa İnhibitör Kullanımı

Abstract

Akut koroner sendrom (AKS) tanısı alan hastalarda genellikle ikili antiplatelet tedavi uygulanmaktadır ki  en sık olarak  asetilsalisilik asit ve tienopiridinler kullanılır. Bu grup hastalar genellikle daha yaşlıdır ve komorbid hastalıklara sahiptirler; bu nedenle olası gastrointestinal kanama riski nedeniyle gastrik korumaya ihtiyaç duyarlar. Koroner yoğun bakımda yatan hastalara  standart tedaviye genellikle proton pompa inhibitörleri (PPI) eklenir. Şu ana kadar PPI ile tienopiridin grubu ilaçlar arasındaki potansiyel etkileşimi değerlendiren birçok çalışma mevcuttur. Çelişkili sonuçlar bulunmuştur; bazı çalışmalarda PPI kullanımı sonrası artmış kardiyovasküler risk görülürken, bazılarında anlamlı klinik fark saptanmamıştır. PPI ile tienopiridin grubu ilaçların birlikte kullanımına kar-zarar oranı göz önünde bulundurularak karar verilmelidir. Daha sonradan piyasaya sürülen PPI’lar (pantoprazol gibi) AKS hastalarında daha güvenilir gözükmektedir. Bu yazıda geçmiş literatür ışığında AKS hastalarında PPI ve tienopiridinlerin birlikte kullanılmasında ortaya çıkabilen bu iyi bilinen ilaç etkileşimi özetlenmektedir.

Keywords

• Tienopiridin,proton pompası inhibitörü,akut koroner sendrom,ilaç etkileşimleri

Concomitant Use of Proton Pump Inhibitors and Thienopyridines in Acute Coronary Syndrome Patients Followed Up in the Intensive Cardiac Care Unit

Abstract

Patients with an established diagnosis of acute coronary syndrome (ACS) require dual antiplatelet therapy, which is most commonly composed of asetil salicylic acid and thienopyridines. This group of patients usually comprises older subjects with comorbid diseases and need gastric protection for potential gastrointestinal bleeding. At the time of admission in intensive cardiac care units, proton pump inhibitors (PPIs) are usually used for standard medical treatment. Several studies have evaluated the potential interaction between PPIs and thienopyridines; however, they have reported conflicting results. Some studies found increased cardiovascular risk after the use of PPIs, whereas others did not detect any clinically significant risk. The rational use of concomitant thienopyridines and PPIs should be decided after weighing their risks against their benefits. The use of latest PPIs such as pantoprazole seems to be safe in ACS patients. This study summarizes the well-known interaction of PPIs and thienopyridines in ACS patients on the basis of previous literature.

Keywords

• Thienopyridine,proton pump inhibitors,acute coronary syndrome,drug interactions

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