ʻO Clopidogrel a me Ticagrelor nā mea kū'ē i ka P2Y12 receptor antagonists e kāohi ana i ka plateboard adenosine diphosphate (ADP) ma ke koho kohoʻana i ka hoʻopaʻaʻana o ka adenosine diphosphate (ADP) i kona papa P2Y12 receptor a me ka hana o ka ADP-mediated glycoprotein GPII.b/III.a complex.

Hoʻohana mau ʻia nā mea ʻelua i nā antiplatellers, hiki ke hoʻohana ʻia no ka pale ʻana i ka thrombosis i nā maʻi me ka angina paʻa mau, acute coronary artery syndrome, a me ka ischemic stroke. No laila he aha ka ʻokoʻa?

1, Ka manawa hoomaka

ʻOi aku ka maikaʻi o Ticagrelor, a no nā poʻe maʻi me ka maʻi maʻi coronary artery maʻi, hiki iā ia ke hana wikiwiki i ka pale ʻana i ka plateplate aggregation, ʻoiai ʻo Clopidogrel ka liʻiliʻi.

2, E lawe i ka pinepine dose

ʻO ka hapalua o ke ola o Clopidogrel he 6 mau hola, aʻo ka hapalua o ke ola o Ticagrelor he 7.2 mau hola.

Eia nō naʻe, paʻa mau nā metabolites ikaika o Clopidogrel i ke kumuhana P2Y12, aʻo ke kumuhana Ticagrelor a me P2Y12 e hoʻohuli ʻia.

No laila, lawe ʻia ʻo Clopidogrel i hoʻokahi manawa i ka lā, a hāʻawi ʻia ʻo Ticagrelor ʻelua i ka lā.

3, hana antiplatelet

Ua ʻoi aku ka maikaʻi o nā antiplatelets o Ticagrelor, a ua hōʻike ʻia nā haʻawina ʻaʻohe ʻokoʻa o Ticagrelor i ka hoʻemi ʻana i ka make cardiovascular a me ka myocardial infarction, ʻoi aku ka kiʻekiʻe ma mua o ka hui Clopidogrel, a me ka hahau.

Ma muli o nā pono o ka mālama ʻana iā Ticagrelor i nā poʻe maʻi me ka maʻi maʻi coronary acute (ACS), nā alakaʻi kūpono i ka home a me nā ʻāina ʻē aʻe e ʻōlelo ʻia e hoʻohana ʻia ʻo Ticagrelor no ka mālama antiplatelet plate i nā maʻi ACS. Ma nā alakaʻi alakaʻi mana ʻelua mai ka European Heart Association (ESC NSTE-ACS Guidelines 2011 a me STEMI Guidelines 2012), hiki ke hoʻohana wale ʻia ʻo Clopidogrel i nā maʻi i hiki ʻole ke mālama ʻia me Ticagrelor.

4, Pilikia o ke koko

ʻOi aku ka kiʻekiʻe o ke koko mai ka hoʻohana lōʻihi ʻana o Ticagrelor ma mua o Clopidogrel, akā ua like ka hopena o ke koko i ka hoʻohana pōkole.

Ua hōʻike ʻia nā haʻawina a KAMIR-NIH e pili ana i ka heluna o ka Hikina Hikina i ka nui o ka nui o ka hemorrhage TIMI i nā maʻi ma mua o 75 mau makahiki ma mua o Clopidogrel. No laila, no ka poʻe maʻi acS ≥ 75 mau makahiki, ua ʻōlelo ʻia e koho ʻo Clopidogrete ma ke ʻano he mea hoʻopaneʻe P2Y12 i makemake ʻia ma ke kumu o ka aspirin.

ʻO ka antiplate platepett therapy no nā poʻe maʻi me nā pā liʻiliʻi liʻiliʻi liʻiliʻi e pale i ke koho o Ticagrelor.

5, Nā hopena ʻino ʻē aʻe

ʻO nā hopena maikaʻi loa i hōʻike ʻia i nā maʻi i mālama ʻia me Ticagrelor he paʻakikī ka hanu ʻana, ka ʻeha a me nā koko ihu, i loaʻa ma kahi kiʻekiʻe ma mua o ka hui Clopidogrel.

6. Nā pilina lāʻau

ʻO Clopidogrel kahi lāʻau lapaʻau presuperial, ka mea i hoʻololi ʻia e CYP2C19 ma ke ʻano he metabolite ikaika, a ʻo ka lawe ʻana i kahi lāʻau e pale ai i ka hana o kēia enzyme hiki ke hōʻemi i ke kiʻekiʻe o ka hoʻololi ʻana o Clopidogrel i kahi metabolite ikaika. No laila, ʻaʻole i ʻōlelo ʻia ka hoʻohana pū ʻana o nā mea paʻa CYP2C19 ikaika a maʻalahi paha e like me omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, camasi.

Hoʻopili nuiʻiaʻo Ticagrelor e CYP3A4, aʻo kahi hapa liʻiliʻi e hoʻopiliʻia e CYP3A5. Hiki i ka hoʻohana pūʻana o CYP3A inhibitors ke hoʻonui i ka Cmax a me ka AUC o ticagrelor. No laila, pono e hōʻoleʻia ka hoʻohanaʻana i ka ticagrelor me nā mea hoʻonāuki CYP3A ikaika e like me ketoconazole, itraconazole, voriconazole, clarithromycin, a me nā mea'ē aʻe. No laila, pono e pale ʻia ka hoʻohana pū ʻana o CYP3A ikaika inducer, e like me dexamethasone, phenytoin sodium, phenobarbital a me carbamazepine.

7、Antiplatelet therapy i nā maʻi me ka lawa ʻole o ka renal

ʻO PLATO, ma kahi noiʻi o nā maʻi me ka maʻi maʻi coronary me ka lawa ʻole o ka renal, ua hōʻike i ka piʻi nui o ka serum creatinine i ka hui ticagrelor i hoʻohālikelike ʻia me clopidogrel; nā hanana, a me ka hana renal pili i nā meaʻino iʻoi aku ka kiʻekiʻe ma ka hui ticagrelor ma mua o ka hui clopidogrel. ʻO clopidogrel + aspirin ke koho mua loa no nā maʻi me ka lawa ʻole o ka renal.

8、Ka lāʻau antiplatelet i nā maʻi me ka gout/hyperuricemia

Uaʻikeʻia ka hoʻohana lōʻihiʻana o ka ticagrelor e hoʻonui i ka hopena o ka gout.ʻO ka maʻi he hopena maʻamau o ka lāʻau ticagrelor, hiki ke pili i ka hopena o nā metabolites ikaika o ka ticagrelor ma ka metabolism uric acid. / maʻi hyperuricemia.

9、Ka lāʻau antiplatelet ma mua o CABG (ka hoʻopili ʻia ʻana o ke aʻa koko coronary)

ʻO nā maʻi i hoʻonohonoho ʻia no CABG e lawe ana i ka aspirin haʻahaʻa haʻahaʻa (75 a 100 mg) ʻaʻole pono e hoʻōki ma mua o ka hana; ʻO nā mea maʻi e loaʻa ana i kahi inhibitor P2Y12 pono e noʻonoʻo e hoʻopau i ka ticagrelor no ka liʻiliʻi o 3 mau lā a me ka clopidogrel no ka liʻiliʻi o 5 mau lā ma mua o ka hana.

10, Haʻahaʻa reactivity o clopidogrel

ʻO ka haʻahaʻa haʻahaʻa o nā platelets i ka clopidogrel hiki ke alakaʻi i ka manawa ischemia. I mea e lanakila ai i ka haʻahaʻa haʻahaʻa o ka clopidogrel, hoʻonui i ka nui o ka clopidogrel a i ʻole ke hoʻololi iā ia me ka ticagrelor he mau koho maʻamau.

I ka hopena, hana wikiwiki ʻo ticagrelor a ʻoi aku ka ikaika o ka pā hopena inhibitory. I ka hoʻomaʻamaʻa ʻana i ka maʻi maʻi coronary acute, ʻoi aku ka maikaʻi o ka ticagrelor i ka hopena antithrombotic, hiki ke hōʻemi hou i ka make, akā ʻoi aku ka nui o ke koko, a ʻoi aku ka nui o nā hopena ʻino e like me dyspnea, contusion, bradycardia, gout a pēlā aku ma mua o clopidogrel.