Clopidogrel ndi Ticagrelor ndi P2Y12 receptor antagonists omwe amaletsa plateboard adenosine diphosphate (ADP) mwa kusankha kuletsa kumanga kwa adenosine diphosphate (ADP) ku plateboard P2Y12 receptor ndi ntchito ya sekondale ADP-mediated glycoprotein GPII.b/III.

Onsewa ndi mankhwala omwe amagwiritsidwa ntchito kwambiri ndi antiplatellers, omwe angagwiritsidwe ntchito poletsa thrombosis kwa odwala omwe ali ndi angina osakhazikika, acute coronary artery syndrome, ndi ischemic stroke. Ndiye pali kusiyana kotani?

1, Nthawi yoyambira

Ticagrelor ndi yothandiza kwambiri, ndipo kwa odwala omwe ali ndi matenda oopsa kwambiri, amatha kuchitapo kanthu mwamsanga kuti alepheretse kuphatikizika kwa plateplate, pamene Clopidogrel sichigwira ntchito.

2, Tengani pafupipafupi mlingo

Theka la moyo wa Clopidogrel ndi maola 6, pamene theka la moyo wa Ticagrelor ndi maola 7.2.

Komabe, metabolites yogwira ya Clopidogrel imamangiriza mosasinthika kumutu wa P2Y12, pomwe mutu wa Ticagrelor ndi P2Y12 umasinthidwa.

Choncho, Clopidogrel amatengedwa kamodzi patsiku, pamene Ticagrelor amaperekedwa kawiri pa tsiku.

3, Antiplatelet kanthu

Ma antiplatelet a Ticagrelor anali othandiza kwambiri, ndipo kafukufuku anasonyeza kuti Ticagrelor analibe kusiyana pakati pa kuchepetsa imfa ya mtima ndi myocardial infarction, yomwe inali yapamwamba kusiyana ndi gulu la Clopidogrel, ndi kupwetekedwa mtima.

Malingana ndi ubwino wa chithandizo cha Ticagrelor kwa odwala omwe ali ndi matenda oopsa kwambiri (ACS), malangizo oyenerera kunyumba ndi kunja amalimbikitsa kuti Ticagrelor agwiritsidwe ntchito pa mankhwala a antiplatelet kwa odwala ACS. Mu malangizo awiri ovomerezeka ochokera ku European Heart Association (ESC NSTE-ACS Guidelines 2011 ndi STEMI Guidelines 2012), Clopidogrel ingagwiritsidwe ntchito kwa odwala omwe sangathe kuchiritsidwa ndi Ticagrelor.

4, Kuopsa kwa magazi

Kuopsa kwa magazi kuchokera ku ntchito kwa nthawi yayitali ya Ticagrelor kunali kochepa kwambiri kuposa Clopidogrel, koma chiopsezo chotaya magazi chinali chofanana ndi ntchito yaifupi.

Kafukufuku wa KAMIR-NIH kutengera kuchuluka kwa anthu aku East Asia akuwonetsa kuti chiwopsezo cha kukha magazi kwa TIMI chinali chokwera kwambiri mwa odwala azaka ≥75 kuposa Clopidogrel. Choncho, kwa odwala acS ≥ zaka 75, ndi bwino kusankha Clopidogrete monga P2Y12 inhibitor yokondedwa pamaziko a aspirin.

Antiplate platepett therapy kwa odwala omwe ali ndi mbale yaing'ono ya mbale ayenera kupewanso njira ya Ticagrelor.

5, Zoyipa zina

Zomwe zimanenedwa kawirikawiri zotsutsana ndi odwala omwe amathandizidwa ndi Ticagrelor zinali zovuta kupuma, kuvulaza ndi mphuno, zomwe zinachitika pamlingo wapamwamba kusiyana ndi gulu la Clopidogrel.

6, Kuyanjana kwamankhwala

Clopidogrel ndi mankhwala a presuperial, omwe amapangidwa ndi gawo limodzi ndi CYP2C19 monga metabolite yogwira, ndipo kumwa mankhwala omwe amalepheretsa ntchito ya enzyme iyi kumachepetsa mulingo womwe Clopidogrel amasinthidwa kukhala metabolite yogwira. Choncho, ophatikizana ntchito amphamvu kapena zolimbitsa CYP2C19 zoletsa monga omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, camasi ali osavomerezeka.

Ticagrelor imapangidwa makamaka ndi CYP3A4, ndipo gawo laling'ono limapangidwa ndi CYP3A5.Kugwiritsiridwa ntchito kwa CYP3A inhibitors kungapangitse Cmax ndi AUC ya ticagrelor. Choncho, kugwiritsa ntchito ticagrelor ndi CYP3A inhibitors amphamvu monga ketoconazole, itraconazole, voriconazole, clarithromycin, ndi zina zotero, ziyenera kupewedwa.Komabe, kugwiritsa ntchito pamodzi CYP3A inducer kungachepetse Cmax ndi AUC ya ticagrelor, motero. Choncho, kuphatikiza ntchito CYP3A wamphamvu inducer, monga dexamethasone, phenytoin sodium, phenobarbital ndi carbamazepine, ayenera kupewa.

7, Antiplatelet mankhwala odwala aimpso insufficiency

PLATO, pofufuza odwala omwe ali ndi vuto lalikulu la coronary ndi kulephera kwaimpso, adawonetsa kuwonjezeka kwakukulu kwa serum creatinine mu gulu la ticagrelor poyerekeza ndi clopidogrel; zochitika, ndi zochitika zoyipa zokhudzana ndi aimpso zinali zapamwamba kwambiri mu gulu la ticagrelor kuposa gulu la clopidogrel. clopidogrel + aspirin ayenera kukhala chisankho choyamba kwa odwala aimpso kulephera.

8, Antiplatelet mankhwala odwala gout/hyperuricemia

Kugwiritsiridwa ntchito kwa ticagrelor kwa nthawi yaitali kwasonyezedwa kuti kumawonjezera chiopsezo cha gout.Gout ndi njira yodziwika bwino ya mankhwala a ticagrelor, omwe angakhale okhudzana ndi zotsatira za metabolites yogwira ntchito ya ticagrelor pa uric acid metabolism.Choncho clopidogrel ndi mankhwala abwino kwambiri a antiplatelet a gout / odwala hyperuricemia.

9, Antiplatelet therapy pamaso pa CABG (coronary artery bypass grafting)

Odwala omwe akukonzekera ku CABG omwe akumwa aspirin yaing'ono (75 kwa 100 mg) sayenera kuima asanagwiritse ntchito; Odwala omwe amalandira P2Y12 inhibitor ayenera kuganizira zosiya ticagrelor kwa masiku osachepera 3 ndi clopidogrel kwa masiku osachepera 5 asanayambe opaleshoni.

10, Low reactivity ya clopidogrel

Kuchepa kwa mapulateleti ku clopidogrel kungayambitse nthawi ya ischemia. Pofuna kuthana ndi reactivity yochepa ya clopidogrel, kuwonjezera mlingo wa clopidogrel kapena m'malo mwake ndi ticagrelor ndizosankha zofala.

Pomaliza, ticagrelor imachita mwachangu ndipo imakhala ndi choletsa champhamvu choletsa. Pochiza matenda oopsa a coronary, ticagrelor ali ndi antithrombotic effect, yomwe imatha kuchepetsa imfa, koma imakhala ndi chiopsezo chachikulu chotaya magazi, ndipo imakhala ndi zotsatira zovuta kwambiri monga dyspnea, contusion, bradycardia, gout ndi zina zotero kuposa clopidogrel.