Clopidogrel le Ticagrelor ke bahanyetsi ba P2Y12 receptor ba thibelang plateboard adenosine diphosphate (ADP) ka ho khetha ho thibela ho tlama ha adenosine diphosphate (ADP) ho plateboard P2Y12 receptor le mosebetsi oa bobeli oa ADP-mediated glycoprotein GPII.b/III.

Ka bobeli ke li-antiplatellers tse sebelisoang hangata ka tleliniking, tse ka sebelisetsoang ho thibela thrombosis ho bakuli ba nang le angina e tsitsitseng e sa foleng, lefu le matla la methapo ea mali le lefu la ischemic.Joale phapang ke efe?

1, Nako ea ho qala

Ticagrelor e sebetsa haholoanyane, 'me ho bakuli ba nang le lefu la methapo ea methapo e matla, e ka nka khato ka potlako ho thibela plateplate aggregation, ha Clopidogrel e sa sebetse hantle.

2, Nka lebelo la lethal dose

Bophelo ba halofo ea Clopidogrel ke lihora tse 6, ha halofo ea bophelo ba Ticagrelor ke lihora tse 7.2.

Leha ho le joalo, metabolites e sebetsang ea Clopidogrel e tlama ka mokhoa o ke keng oa fetoloa ho taba ea P2Y12, ha taba ea Ticagrelor le P2Y12 e ka khutlisoa.

Ka hona, Clopidogrel e nkoa hang ka letsatsi, ha Ticagrelor e fuoa habeli ka letsatsi.

3, ketso ea Antiplatelet

Li-antiplatelet tsa Ticagrelor li ne li atleha haholoanyane, 'me liphuputso li bontšitse hore Ticagrelor e ne e se na phapang ea ho fokotsa lefu la pelo le methapo ea pelo, e neng e phahame ho feta sehlopha sa Clopidogrel, le ho otloa ke lefu.

Ho itšetlehile ka melemo ea phekolo ea Ticagrelor ho bakuli ba nang le lefu la acute coronary syndrome (ACS), tataiso e nepahetseng lapeng le linaheng tse ling e khothalletsa hore Ticagrelor e sebelisoe bakeng sa phekolo ea platelet ea antiplatelet ho bakuli ba ACS.Litaelong tse peli tse nang le matla tse tsoang ho European Heart Association (ESC NSTE-ACS Guidelines 2011 le STEMI Guidelines 2012), Clopidogrel e ka sebelisoa feela ho bakuli ba ke keng ba phekoloa ka Ticagrelor.

4, Kotsi ea ho tsoa mali

Kotsi ea ho tsoa mali ka nako e telele ea tšebeliso ea Ticagrelor e ne e phahame hanyenyane ho feta ea Clopidogrel, empa kotsi ea ho tsoa mali e ne e tšoana le tšebeliso ea nako e khutšoanyane.

Liphuputso tse entsoeng ke KAMIR-NIH tse ipapisitseng le baahi ba Asia Bochabela li bonts'a hore kotsi ea TIMI haemorrhage e phahame haholo ho bakuli ba lilemo tse ≥75 ho feta Clopidogrel.Ka hona, bakeng sa bakuli ba acS ≥ lilemo tse 75, ho kgothaletswa ho khetha Clopidogrete e le e khethiloeng P2Y12 inhibitor motheong oa aspirin.

Antiplate platepett therapy bakeng sa bakuli ba nang le palo e tlaase ea poleiti e nyenyane e boetse e lokela ho qoba khetho ea Ticagrelor.

5. Liphetoho tse ling tse mpe

Litlamorao tse mpe tse tlalehiloeng ka ho fetesisa ho bakuli ba neng ba tšoaroa ka Ticagrelor e ne e le ho hema ka thata, ho senya le ho tsoa mali ka nko, e ileng ea etsahala ka tekanyo e phahameng ho feta sehlopheng sa Clopidogrel.

6. Litšebelisano tsa lithethefatsi

Clopidogrel ke sethethefatsi sa presuperial, se fetotsoeng karolo e 'ngoe ke CYP2C19 joalo ka metabolite ea sona e sebetsang,' me ho nka sethethefatsi se thibelang ts'ebetso ea enzyme ena ho ka fokotsa boemo boo Clopidogrel e fetoloang ho bona metabolite e sebetsang.Ka hona, tšebeliso e kopanetsoeng ea li-inhibitors tse matla kapa tse itekanetseng tsa CYP2C19 tse kang omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, camasi ha e khothalletsoe.

Ticagrelor e sebelisoa haholo ke CYP3A4, 'me karolo e nyenyane e sebelisoa ke CYP3A5. Tšebeliso e kopanetsoeng ea CYP3A inhibitors e ka eketsa Cmax le AUC ea ticagrelor.Ka hona, tšebeliso e kopanetsoeng ea ticagrelor e nang le matla a CYP3A inhibitors e kang ketoconazole, itraconazole, voriconazole, clarithromycin, joalo-joalo, e lokela ho qojoa.Leha ho le joalo, tšebeliso e kopanetsoeng ea CYP3A inducer e ka fokotsa Cmax le AUC ea ticagrelor, ka ho latellana.Ka hona, tšebeliso e kopanetsoeng ea CYP3A e matla ea inducer, e kang dexamethasone, phenytoin sodium, phenobarbital le carbamazepine, e lokela ho qojoa.

7, Phekolo ea Antiplatelet ho bakuli ba nang le ho haella ha renal

PLATO, phuputsong ea bakuli ba nang le lefu la acute coronary syndrome le ho se sebetse ha renal, e bontšitse keketseho e kholo ea serum creatinine sehlopheng sa ticagrelor ha se bapisoa le clopidogrel; liketsahalo, 'me liketsahalo tse mpe tse amanang le ts'ebetso ea renal li ne li phahame haholo sehlopheng sa ticagrelor ho feta sehlopha sa clopidogrel.Ka hona, clopidogrel + aspirin e lokela ho ba khetho ea pele bakeng sa bakuli ba nang le bothata ba renal.

8, Phekolo ea antiplatelet ho bakuli ba nang le gout / hyperuricemia

Tšebeliso ea nako e telele ea ticagrelor e 'nile ea bontšoa hore e eketsa kotsi ea gout.Gout ke mokhoa o tloaelehileng oa phekolo ea ticagrelor, e ka' nang ea amana le phello ea metabolites e sebetsang ea ticagrelor ho uric acid metabolism.Ka hona clopidogrel ke phekolo e nepahetseng ea antiplatelet bakeng sa gout. /bakuli ba hyperuricemia.

9, phekolo ea antiplatelet pele ho CABG (coronary artery bypass grafting)

Bakuli ba reriloeng bakeng sa CABG ba noang aspirin ea tekanyo e tlase (75 ho 100 mg) ha ho hlokahale hore ba emise pele ho ts'ebetso; Bakuli ba fumanang P2Y12 inhibitor ba lokela ho nahana ka ho tlohela ticagrelor bonyane matsatsi a 3 le clopidogrel bonyane matsatsi a 5 pele ho ts'ebetso.

10, Reactivity e tlase ea clopidogrel

Ts'ebetso e tlase ea liplatelete ho clopidogrel e ka lebisa ho nako ea ischemia.E le ho hlōla reactivity e tlaase ea clopidogrel, ho eketsa tekanyo ea clopidogrel kapa ho e nkela sebaka ka ticagrelor ke khetho e tloaelehileng.

Qetellong, ticagrelor e sebetsa ka potlako 'me e na le letlapa le matla la inhibitory effect.Ha ho phekoloa lefu la acute coronary syndrome, ticagrelor e na le phello e ntle ea antithrombotic, e ka fokotsang lefu ka ho eketsehileng, empa e na le kotsi e kholo ea ho tsoa mali, 'me e na le liphello tse phahameng tse mpe tse kang dyspnea, contusion, bradycardia, gout joalo-joalo ho feta clopidogrel.