Clopidogrel na Ticagrelor ni antagonisti ya P2Y12 ibuza plateboard adenosine diphosphate (ADP) guhitamo guhitamo guhuza adenosine diphosphate (ADP) kububiko bwacyo bwa P2Y12 hamwe nibikorwa bya ADP yunganirwa 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 vuba kugirango ibuze gukusanya plateplate, mugihe Clopidogrel idakora neza.

2, Fata inshuro nyinshi

Igice cya kabiri cyubuzima bwa 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

Antiplatelets ya Ticagrelor yarushijeho gukora neza, kandi ubushakashatsi bwerekanye ko Ticagrelor nta tandukaniro yari afite mu kugabanya urupfu rwumutima nimiyoboro yindwara ya myocardial, ikaba yari hejuru ugereranije nitsinda rya Clopidogrel, ndetse no mu bwonko.

Hashingiwe ku nyungu zo kuvura Ticagrelor ku barwayi bafite syndrome ikaze ya coronary (ACS), amabwiriza ajyanye n’imbere mu gihugu ndetse no mu mahanga arasaba ko Ticagrelor yakoreshwa mu kuvura isahani ya antiplatelet ku barwayi ba ACS.Mu mabwiriza abiri yemewe yatanzwe n’ishyirahamwe ry’umutima w’ibihugu by’i Burayi (Amabwiriza ya ESC NSTE-ACS 2011 n’amabwiriza ya STEMI 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 ya Clopidogrel, ariko ibyago byo kuva amaraso byari bisa mugukoresha igihe gito.

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

Antiplate ivura abarwayi bafite isahani ntoya isahani igomba no kwirinda guhitamo Ticagrelor.

5 、 Ibindi bitekerezo bibi

Indwara zikunze kuvugwa ku barwayi bavuwe na Ticagrelor ni ikibazo cyo guhumeka, gukomeretsa no kuva amaraso mu mazuru, byagaragaye 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 imiti ibuza ibikorwa byiyi misemburo bishobora kugabanya urwego Clopidogrel ihinduka metabolite ikora.Kubwibyo rero, gukoresha hamwe gukoresha CYP2C19 inhibitori 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, gukoresha ikoreshwa rya ticagrelor hamwe na CYP3A inhibitori nka ketoconazole, itraconazole, voriconazole, clarithromycin, nibindi, bigomba kwirindwa.Nyamara, hamwe gukoresha CYP3A inducer 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 de acute 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 ihitamo ryambere kubarwayi bafite ikibazo cyo kubura impyiko.

8 therapy Antiplatelet ivura abarwayi bafite gout / hyperuricemia

Gukoresha igihe kirekire ticagrelor byagaragaye ko byongera ibyago byo kurwara.Gout ni ingaruka mbi yo kuvura ticagrelor, ishobora kuba ifitanye isano ningaruka za metabolite ikora ya ticagrelor kuri metabolisme ya uric. Kubwibyo rero clopidogrel nuburyo bwiza bwo kuvura antiplatelet kuri gout / abarwayi ba hyperuricemia.

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

Abarwayi bateganijwe kuri CABG bafata aspirine nkeya (75 kugeza 100 mg) ntibakenera guhagarara mbere yo gutangira; abarwayi bakira inhibitori ya P2Y12 bagomba gutekereza guhagarika ticagrelor byibura iminsi 3 na clopidogrel byibura 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 igipimo cya clopidogrel cyangwa kuyisimbuza ticagrelor nibisanzwe.

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