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

Year 2016, Volume: 19 Issue: 1, 37 - 39, 04.04.2016

Mustafa Ozan Gürsoy , Mustafa Yıldız

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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