title: Proton Pump Inhibitors in Cardiovascular Disease: Drug Interactions with Antiplatelet Drugs.
abstract: Aspirin and P2Y12receptor antagonists are widely used across the spectrum of cardiovascular diseases. Upper gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed.PPIs provide gastroprotection by changing the intragastric milieu, essentially by raising intragastric pH. In recent years, it has been heavily discussed whether PPIs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Pharmacodynamic and pharmacokinetic studies suggested an interaction between PPIs and clopidogrel, and subsequent clinical studies were conducted to evaluate the clinical impact of this interaction. More recently, it was reported that PPIs may also attenuate the antiplatelet effect of aspirin. This may be clinically important, because a fixed combination of aspirin and a PPI (esomeprazole) has recently been approved and because aspirin is the most widely used drug in patients with cardiovascular disease. The antiplatelet effect of the new P2Y12receptor antagonists, ticagrelor and prasugrel, seems less influenced by PPI co-treatment.Given the large number of patients treated with antithrombotic drugs and PPIs, even a minor reduction of platelet inhibition potentially carries considerable clinical impact. The present book chapter summarizes the evidence regarding the widespread use of platelet inhibitors and PPIs in combination. Moreover, it outlines current evidence supporting or opposing drug interactions between these drugs and discusses clinical implications.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. morten.wurtz@clin.au.dk.|Department of Internal Medicine, Regional Hospital West Jutland, Gl. Landevej 61, DK-7400, Herning, Denmark. morten.wurtz@clin.au.dk.
authors.forename: Morten
authors.initials: M
authors.lastname: Würtz
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Erik L
authors.initials: EL
authors.lastname: Grove
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001241:Aspirin / Q000097:blood / Q000493:pharmacokinetics*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D004347:Drug Interactions; D064098:Esomeprazole / Q000097:blood / Q000493:pharmacokinetics*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D015870:Gene Expression; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D010437:Peptic Ulcer / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000097:blood / Q000493:pharmacokinetics*; D058914:Purinergic Antagonists / Q000097:blood / Q000493:pharmacokinetics*; D058925:Receptors, Purinergic P2Y12 / Q000235:genetics / Q000378:metabolism; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics
chemical_list: C548576:P2RY12 protein, human; D054328:Proton Pump Inhibitors; D058914:Purinergic Antagonists; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D064098:Esomeprazole; D013988:Ticlopidine; D001241:Aspirin
keywords: ADP receptor antagonists; Aspirin; Clopidogrel; Drug interactions; Proton pump inhibitors