地域医療と健康教育

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Acenocoumarol and Proton Pump Inhibitors Interaction: Results from a Prospective, Multicenter Study

Grau Bartomeu J, Gallardo Martínez LJ, Olona Tabueña N, Moreno Oliver A and Vallès Callol JA

Background: The interaction between acenocoumarol and omeprazole is described to be possible in different forums even though the evidence shows that both can be prescribed together safely.

Aim: To evaluate the introduction of omeprazole on the effect of acenocoumarol in primary care clinical practice.

Design and setting: Cross-sectional study with prospective follow-up of the patients treated with acenocoumarol for 18 months period in 5 health urban areas.

Method: Association of age, sex, anticoagulant dose, indication and INR values according the use of acenocoumarol and PPI.

Results: Of the 260 patients with acenocoumarol (with 3,280 INR measurements) at the start, 126 (48.5%) had previously been with some PPI (97 took omeprazole, mean INR of 2.43), 134 patients were not taking any PPI at the start of the study. Of the patients not previously treated with a PPI, 52 started with some PPI during the monitoring period; in 47 cases the PPI was omeprazole, 33 (70.2%) of which had an INR within the therapeutic range just before the administration of omeprazole. After the administration of omeprazole, 30 patients (90.9%) remained within the therapeutic range. The mean INR values just before and after the administration of omeprazole were 2.47 and 2.46 respectively (P=0.814).

Conclusion: The addition of omeprazole to patients treated with acenocoumarol did not modify the INR values, reaffirming that there is no drug interaction. Long-term concomitant treatment with acenocoumarol and omeprazole is compatible with the INR measures within the target range.