Clopidogrel uye Ticagrelor iP2Y12 receptor antagonists iyo inhibit plateboard adenosine diphosphate (ADP) nekusarudza kuvharidzira kusunga kweadenosine diphosphate (ADP) kune plateboard yayo P2Y12 receptor uye basa rechipiri ADP-mediated glycoprotein GPII.b/III.

Ose ari maviri ekiriniki anowanzoshandiswa antiplatellers, anogona kushandiswa kudzivirira thrombosis kune varwere vane chisingaperi angina, acute coronary artery syndrome, uye ischemic sitiroko.Saka musiyano wei?

1, Nguva yekutanga

Ticagrelor inonyanya kushanda, uye kune varwere vane acute coronary artery syndrome, inogona kukurumidza kuita kuti inhibit plateplate aggregation, nepo Clopidogrel isinganyanyi kushanda.

2, Tora iyo dose frequency

Iyo hafu yehupenyu hweClopidogrel maawa matanhatu, nepo hafu yeupenyu hweTicagrelor ndeye 7.2 maawa.

Nekudaro, iyo inoshanda metabolites yeClopidogrel inosunga zvisingachinjike kune iyo P2Y12 chidzidzo, nepo Ticagrelor uye P2Y12 chinyorwa ichidzoserwa.

Nokudaro, Clopidogrel inotorwa kamwe chete pazuva, asi Ticagrelor inopiwa kaviri pazuva.

3, Antiplatelet chiito

Ticagrelor's antiplatelet yainyanya kushanda, uye zvidzidzo zvakaratidza kuti Ticagrelor yakanga isina misiyano mukuderedza kufa kwemwoyo uye myocardial infarction, iyo yakanga yakakwirira kudarika muboka reClopidogrel, uye mukurohwa.

Kubva pane zvinobatsira zveTicagrelor kurapwa kune varwere vane acute coronary syndrome (ACS), mazano akakodzera kumba uye kunze kwenyika anokurudzira kuti Ticagrelor ishandiswe kune antiplatelet plate treatment mu ACS varwere.Mumitemo miviri ine chiremera kubva kuEuropean Heart Association (ESC NSTE-ACS Guidelines 2011 uye STEMI Guidelines 2012), Clopidogrel inogona kushandiswa chete kune varwere vasingakwanisi kurapwa neTicagrelor.

4,Ngozi yekubuda ropa

Ngozi yekubuda ropa kubva mukushandiswa kwenguva refu kweTicagrelor yakanga yakakwirira kudarika yeClopidogrel, asi njodzi yekubuda ropa yakanga yakafanana mukushandiswa kwenguva pfupi.

Zvidzidzo zveKAMIR-NIH zvichibva pahuwandu hweEast Asia zvinoratidza kuti njodzi yeTIMI hemorrhage yakakwira zvakanyanya muvarwere vane makore ≥75 kupfuura muClopidogrel.Saka, kune varwere ve acS ≥ makore makumi manomwe neshanu, zvinokurudzirwa kusarudza Clopidogrete seyakasarudzwa P2Y12 inhibitor pahwaro hwe aspirin.

Antiplate platepett therapy kune varwere vane chidimbu cheplate duku nhamba inofanirawo kudzivisa sarudzo yeTicagrelor.

5, Mamwe maitiro akashata

Izvo zvinowanzotaurwa zvakashata zvakashata muvarwere vakabatwa neTicagrelor zvaive zvakaoma kufema, kuputika uye kuputika kwemhino, izvo zvakaitika pamwero wakakwirira kudarika muboka reClopidogrel.

6, Kudyidzana kwezvinodhaka

Clopidogrel ndeye presuperial drug, iyo inogadziriswa muchikamu neCYP2C19 seyayo inoshanda metabolite, uye kutora mushonga unorambidza kuita kweiyo enzyme kunogona kuderedza nhanho iyo Clopidogrel inoshandurwa kuita metabolite inoshanda.Nokudaro, kushandiswa kwakasanganiswa kweCYP2C19 inhibitors yakasimba kana yakadzikama yakadai seomeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, camasi haibvumirwi.

Ticagrelor inonyanya kushandiswa neCYP3A4, uye chikamu chiduku chinogadziriswa neCYP3A5.Kushandiswa kwakasanganiswa kweCYP3A inhibitors kunogona kuwedzera Cmax uye AUC ye ticagrelor.Nokudaro, kusanganiswa kushandiswa kweticagrelor ine simba CYP3A inhibitors yakadai se ketoconazole, itraconazole, voriconazole, clarithromycin, nezvimwewo, inofanira kudziviswa.Zvisinei, kushandiswa pamwe chete kweCYP3A inducer kunogona kuderedza Cmax uye AUC ye ticagrelor, maererano.Nokudaro, kushandiswa kwakasanganiswa kweCYP3A inducer yakasimba, yakadai sedexamethasone, phenytoin sodium, phenobarbital uye carbamazepine, inofanira kudziviswa.

7, Antiplatelet therapy muvarwere vane renal insufficiency

PLATO, mune chidzidzo chevarwere vane acute coronary syndrome vane renal insufficiency, yakaratidza kuwedzera kukuru kweserum creatinine muboka reticagrelor kana ichienzaniswa ne clopidogrel; zviitiko, uye renal function yakabatana nezviitiko zvakashata zvakanyanya zvakanyanya muboka reticagrelor kupfuura muboka re clopidogrel.Saka, clopidogrel + aspirin inofanira kuva sarudzo yekutanga kune varwere vane renal insufficiency.

8, Antiplatelet therapy muvarwere vane gout / hyperuricemia

Kushandiswa kwenguva refu kweticagrelor kwakaratidzwa kuwedzera ngozi yegout.Gout inowanzova yakashata yakashata yeticagrelor kurapwa, iyo inogona kunge yakabatana nemigumisiro yekushanda metabolites ye ticagrelor pane uric acid metabolism.Saka clopidogrel ndiyo yakanyanya kunaka antiplatelet therapy ye gout. / hyperuricemia varwere.

9, Antiplatelet therapy pamberi peCABG (coronary artery bypass grafting)

Varwere vakarongerwa CABG vari kutora yakaderera-dose aspirin (75 kusvika 100 mg) havadi kumira preoperative; Varwere vanogamuchira P2Y12 inhibitor vanofanira kufunga nezvekurega ticagrelor kwemazuva matatu uye clopidogrel kwemazuva mashoma 5 preoperative.

10, Yakaderera reactivity ye clopidogrel

Iyo yakaderera reactivity yemaplatelet kune clopidogrel inogona kutungamira kune ischemia nguva.Kuti akunde yakaderera reactivity ye clopidogrel, kuwedzera muyero we clopidogrel kana kuitsiva ne ticagrelor isarudzo dzakajairika.

Mukupedzisa, ticagrelor inoita nekukurumidza uye ine yakasimba inhibitory effect plate.Mukurapa kweacute coronary syndrome, ticagrelor ine zviri nani antithrombotic effect, iyo inogona kuwedzera kuderedza kufa, asi ine ngozi yakawanda yekubuda ropa, uye ine maitiro akakwirira akashata akadai se dyspnea, contusion, bradycardia, gout nezvimwe zvakadaro kupfuura clopidogrel.