Clopidogrel na Ticagrelor ni P2Y12 yakira reseptor antagonist ibuza platine adenosine diphosphate (ADP) guhitamo guhitamo guhuza diphosphate ya adenosine (ADP) kububiko bwayo bwa P2Y12 hamwe nigikorwa cya kabiri cya ADP cyahujwe na glycoproteine ​​GPII.b / III.a.

Byombi bikoreshwa mubuvuzi bwa antiplatellers, bushobora gukoreshwa mukurinda trombose kubarwayi bafite angina idakira, syndrome de acute coronary arteri, na stroke ischemic. None itandukaniro irihe?

1, Igihe cyo gutangiriraho

Ticagrelor ikora neza, kandi kubarwayi barwaye syndrome ikaze ya coronary arteriire, irashobora gukora byihuse kugirango ibuze gukusanya plateplate, mugihe Clopidogrel idakora neza.

2, Fata inshuro zingana

Igice cya kabiri cya Clopidogrel ni amasaha 6, mugihe igice cya kabiri cya Ticagrelor ni amasaha 7.2.

Nyamara, metabolite ikora ya Clopidogrel ihuza bidasubirwaho ingingo ya P2Y12, mugihe Ticagrelor na P2Y12 isubirwamo.

Kubwibyo, Clopidogrel ifatwa rimwe kumunsi, mugihe Ticagrelor itangwa kabiri kumunsi.

3, Igikorwa cya Antiplatelet

Antiplatelet ya Ticagrelor yarushijeho gukora neza, kandi ubushakashatsi bwerekanye ko Ticagrelor nta tandukaniro yagize mu kugabanya impfu z'umutima n'imitsi ndetse n'indwara ya myocardial, yari hejuru cyane ugereranije n'itsinda rya Clopidogrel, ndetse no mu bwonko.

Hashingiwe ku nyungu zo kuvura Ticagrelor ku barwayi bafite syndrome ikaze ya coronary (ACS), amabwiriza abigenga mu gihugu ndetse no mu mahanga arasaba ko Ticagrelor yakoreshwa mu kuvura plaque ya antiplatelet ku barwayi ba ACS. Mu mabwiriza abiri yemewe n’ishyirahamwe ry’umutima w’uburayi (ESC NSTE-ACS Amabwiriza ya 2011 na STEMI Amabwiriza 2012), Clopidogrel irashobora gukoreshwa gusa ku barwayi badashobora kuvurwa na Ticagrelor.

4, Ibyago byo kuva amaraso

Ibyago byo kuva amaraso bivuye mugihe kirekire cya Ticagrelor byari hejuru gato ugereranije na Clopidogrel, ariko ibyago byo kuva amaraso byari bisa no kubikoresha mugihe gito.

Ubushakashatsi bwakozwe na KAMIR-NIH bushingiye ku baturage bo muri Aziya y'Iburasirazuba bwerekana ko ibyago byo kuva amaraso ya TIMI byari byinshi cyane ku barwayi bafite imyaka ≥ 75 ugereranije na Clopidogrel. Kubwibyo, kubarwayi ba acS years 75 ans, birasabwa guhitamo Clopidogrete nkibikoresho bya P2Y12 byemewe hashingiwe kuri aspirine.

Antiplate platepett ivura abarwayi bafite isahani ntoya ifite isahani ntoya nayo igomba kwirinda amahitamo ya Ticagrelor.

5 、 Ibindi bitekerezo bibi

Ikibazo cyakunze kuvugwa cyane ku barwayi bavuwe na Ticagrelor ni ikibazo cyo guhumeka, gukomeretsa no kuva amaraso mu mazuru, ibyo bikaba byarabaye ku kigero cyo hejuru ugereranije no mu itsinda rya Clopidogrel.

6 actions Imikoreshereze yibiyobyabwenge

Clopidogrel ni imiti igabanya ubukana, ihinduranya igice na CYP2C19 nka metabolite ikora, kandi gufata ibiyobyabwenge bibuza ibikorwa byiyi misemburo bishobora kugabanya urwego Clopidogrel ihinduka metabolite ikora. Kubwibyo, hamwe hamwe gukoresha imbaraga zikomeye cyangwa ziciriritse CYP2C19 inhibitor nka omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, camasi ntabwo byemewe.

Ticagrelor ikoreshwa cyane na CYP3A4, naho igice gito kigahinduka na CYP3A5. Gukoresha hamwe na CYP3A inhibitor birashobora kongera Cmax na AUC ya ticagrelor. Kubwibyo rero, gukoresha ikoreshwa rya ticagrelor hamwe na CYP3A inhibitor zikomeye nka ketoconazole, itraconazole, voriconazole, clarithromycine, nibindi, bigomba kwirindwa.Nyamara, gukoresha hamwe inducer ya CYP3A bishobora kugabanya Cmax na AUC ya ticagrelor. Kubwibyo rero, kwirinda gukoresha CYP3A inducer ikomeye, nka dexamethasone, sodium ya fenytoin, phenobarbital na karbamazepine.

7 therapy Antiplatelet ivura abarwayi bafite ikibazo cyo kubura impyiko

PLATO, mu bushakashatsi bwakozwe ku barwayi bafite syndrome ikaze ya coronary hamwe no kubura impyiko, yerekanye ubwiyongere bukabije bwa serumu creatinine mu itsinda rya ticagrelor ugereranije na clopidogrel; Ubundi isesengura ry’abarwayi bavuwe na ARB ryerekanye ko kwiyongera kwa 50% bya serumu creatinine>, bifitanye isano n’impyiko ibyabaye, nibikorwa byimpyiko bifitanye isano nibintu bibi byari hejuru cyane mumatsinda ya ticagrelor kuruta mumatsinda ya clopidogrel. Kubwibyo, clopidogrel + aspirine igomba kuba guhitamo kwambere kubarwayi bafite ikibazo cyo kubura impyiko.

8 therapy Antiplatelet ivura abarwayi bafite gout / hyperuricemia

Gukoresha ticagrelor igihe kirekire byagaragaye ko byongera ibyago byo kurwara indwara ya gout.Gout ni ingaruka mbi yo kuvura ticagrelor, ishobora kuba ifitanye isano n'ingaruka za metabolite ikora ya ticagrelor kuri metabolisme ya uric.Nuko rero clopidogrel nubuvuzi bwiza bwa antiplatelet kuri gout / abarwayi ba hyperuricemia.

9 therapy Ubuvuzi bwa Antiplatelet mbere ya CABG (coronary artery bypass grafting)

Abarwayi bateganijwe kuri CABG bafata aspirine nkeya (75 kugeza 100 mg) ntibakeneye guhagarara mbere yo gutangira; abarwayi bahabwa inhibitor ya P2Y12 bagomba gutekereza guhagarika ticagrelor byibuze iminsi 3 na clopidogrel byibuze iminsi 5 mbere yo kubitegura.

10 react Ubushobozi buke bwa clopidogrel

Imyitwarire mike ya platine kuri clopidogrel irashobora kuganisha kumwanya wa ischemia. Kugirango tuneshe reaction nkeya ya clopidogrel, kongera urugero rwa clopidogrel cyangwa kuyisimbuza ticagrelor ni amahitamo rusange.

Mugusoza, ticagrelor ikora vuba kandi ifite plaque ikomeye yo kubuza. Mu kuvura syndrome ikaze ya coronary, ticagrelor igira ingaruka nziza ya antithrombotique, ishobora kurushaho kugabanya impfu, ariko ikagira ibyago byinshi byo kuva amaraso, kandi ikagira ingaruka mbi cyane nka dyspnea, contusion, bradycardia, gout nibindi kuruta clopidogrel.