Clopidogrel iyo Ticagrelor waa P2Y12 reseptor antagonists kuwaas oo xannibaya plateboard adenosine diphosphate (ADP) iyaga oo si xushmad leh u xakameynaya xiritaanka adenosine diphosphate (ADP) ee sabuuradaha P2Y12 iyo waxqabadka ADP-dhexdhexaadinta glycoprotein GPII.b/III.a.

Labaduba waa daawooyin caadi ahaan loo isticmaalo antiplatellers, kuwaas oo loo isticmaali karo si looga hortago xinjirowga bukaanka qaba angina joogto ah, xanuunka halbowlaha wadnaha ee degdega ah, iyo ischemic stroke.Haddaba maxay ku kala duwan yihiin?

1, Waqtiga uu bilaabanayo

Ticagrelor waa wax ku ool badan, iyo bukaanada qaba xanuunka halbowlaha wadnaha ee degdega ah, waxay si dhakhso ah u dhaqmi kartaa si loo joojiyo isu-ururinta plateplate, halka Clopidogrel uu waxtar yar yahay.

2, Qaado inta jeer ee qiyaasta

Nolosha kala bar ee Clopidogrel waa 6 saacadood, halka nolosha kala bar ee Ticagrelor ay tahay 7.2 saacadood.

Si kastaba ha ahaatee, dheef-shiid kiimikaadka firfircoon ee Clopidogrel ayaa si aan leexleexad lahayn ugu xidhan mawduuca P2Y12, halka maadada Ticagrelor iyo P2Y12 ay yihiin kuwo la beddeli karo.

Sidaa darteed, Clopidogrel waxaa la qaataa hal mar maalintii, halka Ticagrelor la siiyo laba jeer maalintii.

3, Falka Antiplatelet

Ticagrelor's antiplatelet ayaa aad waxtar u leh, cilmi-baaristuna waxay muujisay in Ticagrelor aysan wax farqi ah u lahayn dhimista dhimashada wadnaha iyo wadnaha wadnaha, taas oo ka sarreysa kooxda Clopidogrel, iyo istaroogga.

Iyada oo ku saleysan faa'iidooyinka daaweynta Ticagrelor ee bukaanka qaba xanuunka wadnaha ee degdega ah (ACS), tilmaamaha ku habboon ee guriga iyo dibadda waxay ku talinayaan in Ticagrelor loo isticmaalo daaweynta saxanka antiplatelet ee bukaanka ACS.Laba tilmaamood oo awood leh oo ka socda Ururka Wadnaha ee Yurub (ESC NSTE-ACS Guidelines 2011 iyo STEMI Guidelines 2012), Clopidogrel waxa kaliya oo loo isticmaali karaa bukaanada aan lagu daawayn karin Ticagrelor.

4,Khatarta dhiigbaxa

Khatarta dhiig-baxa codsiga muddada-dheer ee Ticagrelor ayaa waxyar ka sarreysay kan Clopidogrel, laakiin khatarta dhiig-baxa waxay la mid tahay isticmaalka muddada-gaaban.

Daraasado ay sameeyeen KAMIR-NIH oo ku salaysan dadweynaha Bariga Aasiya waxay muujinayaan in khatarta dhiig-baxa TIMI ay aad uga badan tahay bukaannada da'doodu tahay ≥ 75 marka loo eego Clopidogrel.Sidaa darteed, bukaanka acS ≥ 75 da'da, waxaa lagu talinayaa in ay doortaan Clopidogrete inhibitor P2Y12 ee la door bidayo iyadoo lagu saleynayo aspirin.

Daawaynta Platepett ee loogu talagalay bukaanada leh saxan yar oo saxan yar waa inay sidoo kale ka fogaadaan doorashada Ticagrelor.

5. Dareen-celinta kale ee xun

Dareen-celinta xun ee ugu badan ee laga soo sheegay bukaannada lagu daweeyay Ticagrelor waxay ahaayeen dhib neefsashada, nabarrada iyo dhiig-baxa sanka, kuwaas oo ku dhacay heer ka sarreeya kooxda Clopidogrel.

6. Isdhexgalka daroogada

Clopidogrel waa daawada presuperial, taas oo qayb ahaan lagu dheefshiido by CYP2C19 sida metabolite firfircoon ee firfircoon, iyo qaadashada daroogada ka hortagtaa dhaqdhaqaaqa enzyme this laga yaabaa in la yareeyo heerka uu Clopidogrel loo beddelo metabolite firfircoon.Sidaa darteed, laguma talinayo isticmaalka wadajirka ah ee xooggan ama dhexdhexaadiyeyaasha CYP2C19 sida omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, Camasi.

Ticagrelor inta badan waxaa metabolized by CYP3A4, iyo qayb yar waxaa metabolized by CYP3A5. Isticmaalka la isku daray ee CYP3A inhibitors waxay kordhin kartaa Cmax iyo AUC of ticagrelor.Sidaa darteed, isticmaalka isku-dhafka ah ee ticagrelor ee leh CYP3A inhibitors sida ketoconazole, itraconazole, voriconazole, clarithromycin, iwm., waa in laga fogaadaa.Sidaa darteed, isticmaalka wadajirka ah ee CYP3A kicinta xooggan, sida dexamethasone, phenytoin sodium, phenobarbital iyo carbamazepine, waa in laga fogaadaa.

7. therapy antiplatelet in bukaanada qaba ku filnaanta kelyaha

PLATO, daraasad lagu sameeyay bukaannada qaba xanuunka wadnaha ee degdega ah ee kelyaha, waxay muujisay koror weyn oo ku yimid serum creatinine ee kooxda ticagrelor marka la barbar dhigo clopidogrel dhacdooyinka xun, iyo shaqada kelyaha ee la xidhiidha dhacdooyinka xun ayaa si aad ah uga sarreeya kooxda ticagrelor marka loo eego kooxda clopidogrel. Sidaa darteed, clopidogrel + aspirin waa in ay noqdaan doorashada koowaad ee bukaanada qaba yaraanta kelyaha.

8. Daaweynta Antiplatelet ee bukaanada qaba gout / hyperuricemia

Isticmaalka dheeraadka ah ee ticagrelor ayaa lagu muujiyay in ay kordhiso halista gout.Gout waa falcelin xun oo caadi ah ee daaweynta ticagrelor, taas oo laga yaabo inay la xiriirto saameynta dheef-shiid kiimikaadka firfircoon ee ticagrelor ee dheef-shiid kiimikaadka uric acid.Sidaas darteed clopidogrel waa daaweynta ugu fiican ee antiplatelet ee gout. / bukaanka hyperuricemia.

9. Dawaynta Antiplatelet ka hor CABG

Bukaannada loo qorsheeyay CABG ee qaadanaya asbiriin-yar (75 ilaa 100 mg) uma baahna inay joojiyaan qalliin ka hor; Bukaannada qaadanaya P2Y12 inhibitor waa inay tixgeliyaan joojinta ticagrelor ugu yaraan 3 maalmood iyo clopidogrel ugu yaraan 5 maalmood oo qalliin ka hor ah.

10. falcelinta hoose ee clopidogrel

Dareen-celinta hoose ee platelet ee clopidogrel waxay u horseedi kartaa waqti ischemia.Si looga gudbo falcelinta hoose ee clopidogrel, kordhinta qiyaasta clopidogrel ama lagu beddelo ticagrelor ayaa ah xulashooyin caadi ah.

Gebogebadii, ticagrelor wuxuu u dhaqmaa si dhakhso ah wuxuuna leeyahay saxan saameyn ka hortag ah oo xooggan.Daawaynta xanuunka wadnaha ee ba'an, ticagrelor waxay leedahay saameyn wanaagsan oo antithrombotic ah, taas oo sii yarayn karta dhimashada, laakiin waxay leedahay khatar sare oo dhiig-bax ah, waxayna leedahay falcelin xun oo xun sida dyspnea, contusion, bradycardia, gout iyo wixii la mid ah marka loo eego clopidogrel.