Farqiga u dhexeeya Ticagrelor iyo Clopidogrel

Clopidogrel iyo Ticagrelor waa antagonistayaasha 'P2Y12 receptor antagonists' kuwaas oo xakameynaya saxanka adenosine diphosphate (ADP) iyaga oo si xushmad leh u xakameynaya ku xirnaanta adenosine diphosphate (ADP) ee loo yaqaan 'P2Y12 receptor plate' iyo waxqabadka 'glycoprotein GPII.b / III.a'.

Labaduba waa antiplatellers caafimaad ahaan inta badan la isticmaalo, taas oo loo isticmaali karo in looga hortago dhiig-baxa dhiigga ku dhaca bukaanka qaba angina oo joogto ah, xannuun wadnaha oo ba'an, iyo istaroogga ischemic. Marka maxay ku kala duwan yihiin?

1, Waqtiga bilawga

Ticagrelor ayaa waxtar badan leh, iyo bukaanka qaba xanuun wadnaha oo ba'an, waxay si dhakhso leh wax uga qaban kartaa in la joojiyo isu-soo-ururinta saxaaxa, halka Clopidogrel uusan waxtar badan lahayn.

2, Qaado inta jeer ee aad qaadanaysid

Nolosha nuska Clopidogrel waa 6 saacadood, halka nolosha badhkeed Ticagrelor ay tahay 7.2 saacadood.

Si kastaba ha noqotee, dheef-shiid kiimikaadka firfircoon ee Clopidogrel ayaa si aan macquul ahayn ugu xiraya mawduuca P2Y12, halka mawduuca Ticagrelor iyo P2Y12 uu yahay mid la beddeli karo.

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

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3, Tallaabada Antiplatelet

Antiplatelet-ka 'Ticagrelor' wuxuu ahaa mid waxtar badan, daraasadaha ayaa muujiyay in Ticagrelor uusan wax farqi ah u laheyn yareynta dhimashada wadnaha iyo cudurka myocardial infarction, oo ka sarreeyay kan kooxda Clopidogrel, iyo istaroogga.

Iyada oo ku saleysan faa'iidooyinka daaweynta Ticagrelor ee bukaannada qaba cudurrada halista ah ee wadnaha (ACS), tilmaamaha ku habboon ee gudaha iyo dibaddaba waxay ku talinayaan in Ticagrelor loo isticmaalo daaweynta saxanka antiplatelet ee bukaannada ACS. Labo tilmaam oo awood leh oo ka socda Ururka Wadnaha Wadnaha ee Yurub (Tilmaamaha ESC NSTE-ACS 2011 iyo Tilmaamaha STEMI 2012), Clopidogrel waxaa loo isticmaali karaa oo keliya bukaanada aan lagu daaweyn karin Ticagrelor.

4, Khatarta dhiigbaxa

Khatarta dhiigbaxa ee isticmaalka muddada-dheer ee Ticagrelor way ka yara sarraysay tan Clopidogrel, laakiin halista dhiig-baxa waxay la mid ahayd isticmaalka muddada-gaaban.

Daraasado ay samaysay KAMIR-NIH oo ku saleysan dadka ku nool Bariga Aasiya ayaa muujinaya in halista TIMI dhiig-baxa ay aad ugu sarreyso bukaannada da'doodu udhaxeyso ≥ 75 marka loo eego Clopidogrel. Sidaa darteed, bukaanjiifka acS ≥ 75 sano jir, waxaa lagugula talinayaa inaad doorato Clopidogrete oo ah ka doorbidida P2Y12 kahortaga asbiriinka

Daaweynta 'plateptet therapy' ee loogu talagalay bukaannada leh saxan hooseeya tirooyinka yar yar waa inay sidoo kale ka fogaadaan xulashada Ticagrelor.

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5 Falcelinno kale oo xun

Dareen-celinta ugu badan ee la soo sheego ee bukaannada lagu daaweeyay Ticagrelor waxay ahaayeen dhib neefsashada, nabarro iyo dheecaanno sanka, oo ka dhacay heer ka sarreeya kan kooxda Clopidogrel.

6 intera Isdhexgalka daroogada

Clopidogrel waa daawo horay loo sii qorsheeyay, taas oo qayb ka mid ah lagu beddelay CYP2C19 iyada oo ah dheef-shiid kiimikaad firfircoon, iyo qaadashada dawo ka hortageysa waxqabadka enzyme-kan ayaa yareyn kara heerka Clopidogrel loogu beddelayo dheef-shiid kiimikaad firfircoon Sidaa darteed, isticmaalka isku-darka ee kahortagayaasha 'CYP2C19 inhibitors' sida omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, camasi laguma talinayo.

Ticagrelor waxaa badanaa lagu shubaa CYP3A4, qayb yarna waxaa lagu qaadaa CYP3A5. Isticmaalka isku dhafan ee ka hortagayaasha CYP3A wuxuu kordhin karaa Cmax iyo AUC ee ticagrelor. Sidaa darteed, waa in laga fogaadaa isku darka isticmaalka ticagrelor-ka ee leh ka hortagayaasha 'CYP3A inhibitors' sida 'ketoconazole, itraconazole, voriconazole, clarithromycin, iwm. Sidaa darteed, isku darka isticmaalka CYP3A inducer xoog leh, sida dexamethasone, phenytoin sodium, phenobarbital iyo carbamazepine, waa in laga fogaadaa.

7 Daaweynta Antiplatelet ee bukaanka qaba kelyaha oo aan ku filnayn

PLATO, daraasad ku saabsan bukaanada qaba cudurrada halista ah ee wadnaha oo kelyaha ku yar, waxay muujiyeen koror aad u sarreeya ee serin creatinine ee kooxda ticagrelor marka la barbardhigo clopidogrel; Falanqaynta dheeriga ah ee bukaannada lagu daaweeyay ARB waxay muujisay 50% kordhinta serum creatinine>, kelyaha oo xun dhacdooyinka, iyo shaqooyinka kelyaha ee la xiriira dhacdooyinka xun waxay si aad ah uga sarreeyeen kooxda ticagrelor-ka marka loo eego kooxda loo yaqaan 'clopidogrel group' .Sidaas darteed, clopidogrel + aspirin waa inuu noqdaa xulashada koowaad ee bukaanada qaba kelyaha oo aan ku filneyn.

8 therapy Daaweynta antiplatelet ee bukaanka qaba gout / hyperuricemia

Isticmaalka ticagrelor-ka ee dheeraadka ah ayaa la muujiyey inay kordhineyso halista gout.Gout waa falcelin aan caadi aheyn oo saameyn ku leh daaweynta ticagrelor, taas oo laga yaabo inay la xiriirto saameynta dheef-shiid kiimikaadka firfircoon ee ticagrelor ee ku saabsan dheef-shiid kiimikaadka uric acid. / bukaanka hyperuricemia.

9 therapy Daaweynta Antiplatelet kahor CABG (tallaalka wadnaha halbowlaha wadnaha)

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

10 re Falcelinta hoose ee clopidogrel

Falcelinta hoose ee platelet-ka ee loo yaqaan 'clopidogrel' waxay u horseedi kartaa waqtiga ischemia. Si looga adkaado falcelinta hoose ee clopidogrel, kordhinta qiyaasta clopidogrel ama lagu beddelo ticagrelor waa xulashooyinka guud.

 

Gabagabadii, ticagrelor dhaqso ayuu wax u qabtaa wuxuuna leeyahay saxan saameyn xoog leh oo xaddidan. Daaweynta cudurka daran ee wadnaha, ticagrelor wuxuu leeyahay saameyn wanaagsan antithrombotic, taas oo sii yareyn karta dhimashada, laakiin waxay leedahay halista sare ee dhiigbaxa, waxayna leedahay dareen celin xun sida dyspnea, Contusion, bradycardia, gout iyo wixii la mid ah clopidogrel.


Waqtiga boostada: Mar-22-2021