Clopidogrel da Ticagrelor su ne antagonists masu karɓa na P2Y12 waɗanda ke hana plateboard adenosine diphosphate (ADP) ta hanyar zaɓin hana ɗaurin adenosine diphosphate (ADP) zuwa mai karɓar farantin sa na P2Y12 da kuma ayyukan glycoprotein na ADP na biyu na GPII.b/III.a.

Dukansu sune magungunan da aka fi amfani da su a asibiti, waɗanda za a iya amfani da su don hana thrombosis a cikin marasa lafiya tare da angina na yau da kullum, ciwo mai tsanani na jijiyoyin jini, da bugun jini na ischemic.To mene ne bambanci?

1, Lokacin farawa

Ticagrelor ya fi tasiri, kuma ga marasa lafiya da ke fama da ciwo mai tsanani na jijiyoyin jini, zai iya yin aiki da sauri don hana haɗin plateplate, yayin da Clopidogrel ba shi da tasiri.

2, Dauki mitar kashi

Rabin rayuwar Clopidogrel shine awanni 6, yayin da rabin rayuwar Ticagrelor shine awanni 7.2.

Koyaya, metabolites masu aiki na Clopidogrel suna da alaƙa da batun P2Y12 ba tare da juyowa ba, yayin da batun Ticagrelor da P2Y12 ke juyawa.

Don haka, ana shan Clopidogrel sau ɗaya a rana, yayin da Ticagrelor ana ba da shi sau biyu a rana.

3, aikin Antiplatelet

Magungunan antiplatelet na Ticagrelor sun fi tasiri, kuma nazarin ya nuna cewa Ticagrelor ba shi da bambanci wajen rage mutuwar zuciya da jijiyoyin jini, wanda ya fi girma a cikin rukunin Clopidogrel, da kuma bugun jini.

Dangane da fa'idodin Ticagrelor ga marasa lafiya tare da ciwo mai tsanani na jijiyoyin jini (ACS), jagororin da suka dace a gida da waje sun ba da shawarar cewa Ticagrelor za a yi amfani da shi don maganin antiplatelet a cikin marasa lafiya na ACS.A cikin ka'idoji guda biyu masu iko daga Ƙungiyar Zuciya ta Turai (ESC NSTE-ACS Guidelines 2011 da STEMI Guidelines 2012), za a iya amfani da Clopidogrel kawai a cikin marasa lafiya waɗanda ba za a iya bi da su tare da Ticagrelor ba.

4,Hadarin zubar jini

Hadarin zubar jini daga aikace-aikacen dogon lokaci na Ticagrelor ya dan kadan sama da na Clopidogrel, amma haɗarin zubar jini ya kasance iri ɗaya a cikin ɗan gajeren lokaci.

Nazarin da KAMIR-NIH ya yi dangane da yawan mutanen Gabashin Asiya ya nuna cewa haɗarin zubar jini na TIMI ya fi girma a cikin marasa lafiya da shekaru ≥ 75 fiye da na Clopidogrel.Don haka, ga marasa lafiya na acS ≥ 75 shekaru, ana ba da shawarar zaɓar Clopidogrete azaman mai hana P2Y12 da aka fi so akan aspirin.

Maganin rigakafin platepett ga marasa lafiya da ƙananan faranti ƙananan faranti ya kamata su guje wa zaɓi na Ticagrelor.

5. Wasu m halayen

Abubuwan da aka fi sani da mummunan sakamako a cikin marasa lafiya da aka bi da su tare da Ticagrelor sune wahalar numfashi, kumburi da zubar da jini, wanda ya faru a mafi girma fiye da ƙungiyar Clopidogrel.

6. Mu'amalar miyagun kwayoyi

Clopidogrel magani ne na presuperial, wanda aka daidaita shi a cikin sashi ta hanyar CYP2C19 azaman metabolite mai aiki, kuma shan wani magani wanda ke hana ayyukan wannan enzyme na iya rage matakin da Clopidogrel ya canza zuwa metabolite mai aiki.Don haka, ba a ba da shawarar yin amfani da masu hana masu hana CYP2C19 masu ƙarfi ko matsakaici kamar omeprazole, Esomeprazole, fluoronazole, voliconazole, fluoxetine, fluorovolsamine, cycloproxacin, Camasi ba.

Ticagrelor yawanci ana daidaita shi ta hanyar CYP3A4, kuma ƙaramin sashi yana daidaitawa ta hanyar CYP3A5. Haɗin amfani da masu hana CYP3A na iya ƙara Cmax da AUC na ticagrelor.Sabili da haka, ya kamata a guje wa haɗuwa da yin amfani da ticagrelor tare da masu hana CYP3A masu ƙarfi irin su ketoconazole, itraconazole, voriconazole, clarithromycin, da dai sauransu.Don haka, ya kamata a guji yin amfani da haɗin gwiwar CYP3A mai ƙarfi mai ƙarfi, kamar dexamethasone, phenytoin sodium, phenobarbital da carbamazepine.

7.Antiplatelet far a marasa lafiya tare da renal insufficiency

PLATO, a cikin nazarin marasa lafiya tare da ciwo mai tsanani na jijiyoyin jini tare da gazawar koda, ya nuna karuwa mai yawa a cikin ƙwayar creatinine a cikin rukunin ticagrelor idan aka kwatanta da clopidogrel; Ƙarin bincike na marasa lafiya da aka bi da su tare da ARB ya nuna karuwar 50% a cikin maganin creatinine>, rashin lafiyar koda. abubuwan da suka faru, da aikin koda da ke da alaƙa da abubuwan da ba su da kyau sun kasance mafi girma a cikin ƙungiyar ticagrelor fiye da a cikin rukunin clopidogrel.Saboda haka, clopidogrel + aspirin ya kamata ya zama zabi na farko ga marasa lafiya da rashin gazawar koda.

8. Antiplatelet far a marasa lafiya da gout / hyperuricemia

An nuna yin amfani da ticagrelor na tsawon lokaci don ƙara haɗarin gout.Gout wani mummunan sakamako ne na maganin ticagrelor, wanda zai iya kasancewa da alaka da tasirin metabolites masu aiki na ticagrelor akan metabolism na uric acid.Saboda haka clopidogrel shine mafi kyawun maganin antiplatelet don gout. /masu fama da hyperuricemia.

9.Antiplatelet far kafin CABG (coronary artery bypass grafting)

Marasa lafiya da aka tsara don CABG waɗanda ke shan aspirin mai ƙarancin ƙarfi (75 zuwa 100 MG) ba sa buƙatar tsayawa da wuri; Marasa lafiya da ke karɓar mai hana P2Y12 yakamata suyi la'akari da dakatar da ticagrelor na aƙalla kwanaki 3 da clopidogrel na akalla kwanaki 5 kafin a fara aiki.

10. Low reactivity na clopidogrel

Rashin amsawar platelet zuwa clopidogrel na iya haifar da lokacin ischemia.Don shawo kan ƙarancin reactivity na clopidogrel, ƙara yawan adadin clopidogrel ko maye gurbin shi da ticagrelor zaɓi ne gama gari.

A ƙarshe, ticagrelor yana aiki da sauri kuma yana da farantin tasirin hanawa mai ƙarfi.A cikin maganin cututtukan zuciya mai tsanani, ticagrelor yana da sakamako mai kyau na antithrombotic, wanda zai iya rage yawan mace-mace, amma yana da haɗari mafi girma na zubar jini, kuma yana da mummunan halayen kamar dyspnea, contusion, bradycardia, gout da sauransu fiye da clopidogrel.