Clopidogrel na Ticagrelor bụ ndị na-emegide ndị na-anabata P2Y12 na-egbochi plateboard adenosine diphosphate (ADP) site na nhọrọ na-egbochi njikọ nke adenosine diphosphate (ADP) na plateboard P2Y12 receptor na ọrụ nke ADP-mediated glycoprotein GPII.b/III.a complex.

Ha abụọ bụ ọgwụ antiplateller nke a na-ejikarị eme ihe n'ụlọ ọgwụ, nke enwere ike iji gbochie thrombosis na ndị ọrịa nwere angina kwụsiri ike na-adịghị ala ala, nnukwu ọrịa akwara obi, na ọrịa strok ischemic.Yabụ kedu ihe dị iche?

1, Oge mmalite

Ticagrelor dị irè karị, yana maka ndị ọrịa nwere nnukwu ọrịa akwara obi, ọ nwere ike ime ngwa ngwa iji gbochie nchịkọta plateplate, ebe Clopidogrel adịghị arụ ọrụ.

2, Were dose ugboro ugboro

Ọkara ndụ nke Clopidogrel bụ awa 6, ebe ọkara ndụ Ticagrelor bụ awa 7.2.

Agbanyeghị, metabolites na-arụ ọrụ nke Clopidogrel na-ejikọta ya na isiokwu P2Y12, ebe isiokwu Ticagrelor na P2Y12 na-atụgharị.

Ya mere, a na-ewere Clopidogrel otu ugboro n'ụbọchị, ebe a na-enye Ticagrelor ugboro abụọ n'ụbọchị.

3, Antiplatelet omume

Ticagrelor's antiplatelet dị irè karị, nchọpụta na-egosikwa na Ticagrelor enweghị ihe dị iche n'ịbelata ọnwụ obi na ọrịa myocardial, nke dị elu karịa otu Clopidogrel, na ọrịa strok.

Dabere na uru nke ọgwụgwọ Ticagrelor na ndị ọrịa nwere nnukwu ọrịa obi na-arịa ọrịa obi (ACS), ụkpụrụ nduzi dị mkpa n'ụlọ na ná mba ọzọ na-atụ aro ka a na-eji Ticagrelor maka ọgwụgwọ efere antiplatelet na ndị ọrịa ACS.Na ntuziaka ikike abụọ sitere na European Heart Association (ESC NSTE-ACS Guidelines 2011 na STEMI Guidelines 2012), enwere ike iji Clopidogrel naanị na ndị ọrịa na-enweghị ike ịgwọ ya na Ticagrelor.

4,Ihe ize ndụ nke ọbara ọgbụgba

Ihe ize ndụ nke ọbara ọgbụgba site na itinye ogologo oge nke Ticagrelor dị elu karịa nke Clopidogrel, mana ihe ize ndụ nke ọbara ọgbụgba yiri ya na iji obere oge.

Nnyocha nke KAMIR-NIH dabere na ọnụ ọgụgụ ndị East Asia na-egosi na ihe ize ndụ nke ọbara ọgbụgba TIMI dị elu nke ukwuu na ndị ọrịa gbara afọ ≥ 75 karịa na Clopidogrel.Ya mere, maka ndị ọrịa acS ≥ 75 afọ, a na-atụ aro ka ịhọrọ Clopidogrete dị ka ihe mgbochi P2Y12 na-ahọrọ na ndabere nke aspirin.

Ọgwụ mgbochi platepett maka ndị ọrịa nwere obere efere dị obere kwesịrị izere nhọrọ Ticagrelor.

5. Ndị ọzọ oghom Jeremaya mere

Mmeghachi omume ọjọọ a na-akọkarị na ndị ọrịa a na-emeso Ticagrelor bụ ike iku ume, ọnya na ọbara imi, nke mere na ọnụ ọgụgụ dị elu karịa na otu Clopidogrel.

6, Mmekọrịta ọgwụ ọjọọ

Clopidogrel bụ ọgwụ presuperial, nke metabolized na akụkụ nke CYP2C19 dị ka metabolite na-arụ ọrụ ya, yana ị were ọgwụ na-egbochi ọrụ enzyme a nwere ike ibelata ọkwa nke mgbanwe Clopidogrel ka ọ bụrụ metabolite na-arụ ọrụ.Ya mere, a naghị atụ aro ijikọ ọnụ nke ihe mgbochi CYP2C19 siri ike ma ọ bụ agafeghị oke dịka omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, camasi.

A na-eme Ticagrelor tumadi site na CYP3A4, na obere akụkụ bụ metabolized site na CYP3A5. Ejikọtara ojiji nke CYP3A inhibitors nwere ike ịbawanye Cmax na AUC nke ticagrelor.Ya mere, a ga-ezere iji ngwakọta nke ticagrelor na ndị na-egbochi CYP3A dị ike dị ka ketoconazole, itraconazole, voriconazole, clarithromycin, wdg.Ya mere, ijikọ ojiji nke CYP3A ike inducer, dị ka dexamethasone, phenytoin sodium, phenobarbital na carbamazepine, kwesịrị izere.

7, Antiplatelet ọgwụgwọ na-arịa ọrịa na gbasara akụrụ insufficiency

PLATO, n'ime nnyocha nke ndị ọrịa nwere nnukwu ọrịa obi na-arịa ọrịa akụrụ na-adịghị ezughi oke, gosipụtara mmụba dị ukwuu na serum creatinine na otu ticagrelor ma e jiri ya tụnyere clopidogrel, nyocha ọzọ nke ndị ọrịa na-emeso ARB gosipụtara mmụba 50% na serum creatinine>, ihe ọjọọ metụtara gbasara akụrụ. ihe omume, na ọrụ gbasara akụrụ ọrụ ndị metụtara ọrịa na-adị elu nke ukwuu na otu ticagrelor karịa na otu clopidogrel. Ya mere, clopidogrel + aspirin kwesịrị ịbụ nhọrọ mbụ maka ndị ọrịa nwere ụkọ akụrụ.

8, Antiplatelet ọgwụgwọ na-arịa ọrịa na gout / hyperuricemia

E gosipụtara iji ticagrelor ogologo oge iji mee ka ohere nke gout dịkwuo elu. Gout bụ mmeghachi omume ọjọọ nke ọgwụgwọ ticagrelor, nke nwere ike jikọta na mmetụta nke metabolites na-arụ ọrụ nke ticagrelor na metabolism uric acid. Ya mere clopidogrel bụ ọgwụgwọ antiplatelet kacha mma maka gout. / ndị ọrịa hyperuricemia.

9, Antiplatelet ọgwụgwọ tupu CABG (coronary akwara uzo grafting)

Ndị ọrịa akwadoro maka CABG ndị na-ewere aspirin dị ala (75 ruo 100 mg) adịghị mkpa ịkwụsị tupu ha emee ya, ndị ọrịa na-anata P2Y12 inhibitor kwesịrị ịtụle ịkwụsị ticagrelor opekata mpe ụbọchị 3 yana clopidogrel ma ọ dịkarịa ala ụbọchị 5 tupu ịwa ahụ.

10, obere reactivity nke clopidogrel

Mmeghachi omume dị ala nke platelet na clopidogrel nwere ike ibute oge ischemia.Iji merie mmeghachi omume dị ala nke clopidogrel, ịba ụba dose nke clopidogrel ma ọ bụ dochie ya na ticagrelor bụ nhọrọ a na-ahụkarị.

Na mmechi, ticagrelor na-eme ngwa ngwa ma nwee mmetụta mgbochi mgbochi siri ike karị.Na ọgwụgwọ nke nnukwu ọrịa obi na-arịa ọrịa obi, ticagrelor nwere mmetụta antithrombotic ka mma, nke nwere ike ibelata ọnwụ, ma ọ nwere nnukwu ihe ize ndụ nke ọbara ọgbụgba, ma nwee mmeghachi omume ọjọọ dị ka dyspnea, contusion, bradycardia, gout na ndị ọzọ karịa clopidogrel.