氯吡格雷与质子泵抑制剂同服可能导致心脏病复发

看了楼主的帖子，不由得精神为之一振，自觉七经八脉为之一畅，七窍倒也开了六巧半。。。（以上略去3600字） 好帖啊，万分感谢！
补充：看了原文，是2009-1-31发布的最新资讯

1: Thromb Haemost. 2009 Apr;101(4):714-9.

Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel.

Sibbing D, Morath T, Stegherr J, Braun S, Vogt W, Hadamitzky M, Schömig A,
Kastrati A, von Beckerath N.

Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Lazarettstrasse
36, 80636 München, Germany. E-mail: dirk@sibbing.net.

Patients receiving dual antiplatelet treatment with aspirin and clopidogrel are
commonly treated with proton pump inhibitors (PPIs). Attenuating effects on
platelet response to clopidogrel have been reported solely for the PPI
omeprazole. PPIs differ in their metabolisation properties as well as their
potential for drug-drug interactions. The aim of this study was to investigate
the impact of different PPIs (pantoprazole, omeprazole, esomeprazole) on platelet
response to clopidogrel in patients with previous coronary stent placement under
chronic clopidogrel treatment. In a cross-sectional observational study,
consecutive patients under clopidogrel maintenance treatment (n = 1,000)
scheduled for a control coronary angiography were enrolled. Adenosine diphosphate
(ADP)-induced platelet aggregation (in AU*min) was measured with multiple
electrode platelet aggregometry (MEA). From the entire study population, 268
(26.8%) patients were under PPI treatment at the time point of platelet function
testing (pantoprazole, n = 162; omeprazole, n = 64; esomeprazole, n = 42).
Platelet aggregation (median [interquartile range]) was significantly higher in
patients with omeprazole treatment (295.5 [193.5-571.2] AU*min) compared to
patients without PPI treatment (220.0 [143.8-388.8] AU*min; p = 0.001). Platelet
aggregation was similar in patients with pantoprazole (226.0 [150.0-401.5]
AU*min) or esomeprazole (209.0 [134.8-384.8] AU*min) treatment compared to
patients without PPI treatment (p = 0.69 and p = 0.88, respectively). Attenuating
effects of concomitant PPI treatment on platelet response to clopidogrel were
restricted to the use of omeprazole. No attenuating effects on platelet response
to clopidogrel were observed for pantoprazole or esomeprazole. Specifically
designed and randomized clinical studies are needed to define the impact of
concomitant PPI treatment on adverse events after percutaneous coronary
intervention.

事实上，目前看来PPI中奥美拉唑的影响比较明确，其它的PPI似乎证据还不足。

根据美国心脏协会，美国胃肠病学学院和美国心脏病学院的建议，所有心脏病发作后接受阿司匹林治疗的60岁以上的病人都应服用质子泵抑制剂，以防止胃出血。
我正寻找阿司匹林+质子泵抑制剂的依据。谢谢楼主。也谢谢站长建立这麽好的网站。