{"id":12737,"date":"2009-03-25T20:00:00","date_gmt":"2009-03-25T20:00:00","guid":{"rendered":""},"modified":"2009-03-25T20:00:00","modified_gmt":"2009-03-25T20:00:00","slug":"protonu-pompos-inhibitoriu-saveika-su-kitais-vaistais","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/protonu-pompos-inhibitoriu-saveika-su-kitais-vaistais\/12737\/","title":{"rendered":"Proton\u0173 pompos inhibitori\u0173 s\u0105veika su kitais vaistais"},"content":{"rendered":"

PROTON\u0172 POMPOS INHIBITORI\u0172 S\u0104VEIKA SU KLOPIDOGRELIU MA\u017dINA JO TERAPIN\u012e VEIKSMINGUM\u0104<\/p>\n

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Pagal Juurlink DN, Gomes T, Ko DT, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 2009;180(7).<\/p>\n

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\u012eVADAS<\/p>\n

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Trombocit\u0173 aktyvacija ir agregacija yra esminiai koronarini\u0173 sindrom\u0173 patogenez\u0117s elementai. Tod\u0117l trombocit\u0173 funkcij\u0105 slopinantys vaistai yra svarbi koronarine \u0161irdies liga sergan\u010di\u0173 pacient\u0173 gydymo priemon\u0117. Klopidogrelio ir aspirino derinys labiau nei vien aspirinas suma\u017eina pakartotini\u0173 koronarini\u0173 \u012fvyki\u0173 rizik\u0105 po persirgto \u016bminio miokardo infarkto (1). Klopidogrelio veiksmingumas yra pagr\u012fstas \u012frodymais. Nustatyta, kad atid\u0117jus gydym\u0105 klopidogreliu, j\u012f apribojant ar per anksti nutraukus padid\u0117ja nepalanki\u0173 \u0161irdies ir kraujagysli\u0173 i\u0161ei\u010di\u0173 rizika (2\u20135).<\/p>\n

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Klopidogrelis yra vaistas-pirmtakas, kuris kepenyse ver\u010diamas \u012f aktyv\u0173 tiolo metabolit\u0105, kuris negr\u012f\u017etamai slopina trombocit\u0173 P2Y12 adenozino difosfato receptorius (6, 7). \u0160ioje biologin\u0117je klopidogrelio aktyvacijoje dalyvauja kepen\u0173 citochromo P450 izofermentai. Svarbiausias i\u0161 j\u0173 \u2013 citochromas P450 2C19 (8), jo veikla turi labai didel\u0119 reik\u0161m\u0119 klopidogrelio antitrombocitiniam poveikiui. Pacient\u0173, turin\u010di\u0173 \u012fgimt\u0105 \u0161io fermento defekt\u0105 ir sutrikui\u0105 funkcij\u0105, organizme susidaro ma\u017eesnis klopidogrelio aktyvaus metabolito kiekis, tod\u0117l suma\u017e\u0117ja trombocit\u0173 funkcijos slopinimas ir padid\u0117ja nepalanki\u0173 \u0161irdies ir kraujagysli\u0173 sistemos \u012fvyki\u0173 rizika, palyginti su pacientais, kuriems \u0161io fermento funkcija normali (9, 10). Kadangi citochromo P450 2C19 vaidmuo klopidogrelio bioaktyvacijai yra didelis, vaistai, kurie slopina \u0161\u012f ferment\u0105, gali suma\u017einti klopidogrelio antitrombocitin\u012f poveik\u012f. <\/p>\n

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Proton\u0173 pompos inhibitoriai (PPI) yra vieni da\u017eniausiai visame pasaulyje i\u0161ra\u0161om\u0173 vaist\u0173 (Kanadoje 2004 m. i\u0161ra\u0161yta daugiau nei 12,4 mln. recept\u0173 jiems \u012fsigyti) (11). Remiantis \u012frodymais, kai kurie PPI gali slopinti citochrom\u0105 P450 2C19 ir taip sutrikdyti klopidogrelio farmakokinetik\u0105 bei padidinti nepalanki\u0173 \u0161irdies ir kraujagysli\u0173 sistemos i\u0161ei\u010di\u0173 rizik\u0105 (12\u201315). <\/p>\n

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I\u0161tyrus didel\u0117s rizikos grup\u0117s pacientus, kuriems atlikta \u0161irdies vainikini\u0173 kraujagysli\u0173 angioplastika ir skirtas gydymas aspirinu bei klopidogreliu, nustatyta, kad jiems omeprazolis reik\u0161mingai suma\u017eino klopidogrelio antitrombocitin\u012f poveik\u012f (14) \u2013 \u016bminio miokardo infarkto rizika tiems, kurie kartu su klopidogreliu vartojo PPI, buvo daugiau nei 300 procent\u0173 (3 kartus) didesn\u0117 nei tiems, kurie nevartojo PPI (16). Ta\u010diau \u0161iuose tyrimuose dalyvavo palyginti <\/span>nedaug pacient\u0173,tod\u0117l i\u0161vados gal\u0117jo b\u016bti nepatikimos.<\/p>\n

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Neseniai paskelbtose gair\u0117se daugumai pacient\u0173, gydyt\u0173 aspirinu po \u016bminio miokardo infarkto, si\u016bloma skirti PPI (17). Dauguma \u0161i\u0173 pacient\u0173 taip pat vartos ir klopidogrel\u012f. Taigi, tik\u0117tina, kad milijonai pacient\u0173 visame pasaulyje vartos PPI ir klopidogrelio derin\u012f. Koki\u0105 \u012ftak\u0105 nepalanki\u0173 kardiovaskulini\u0173 i\u0161ei\u010di\u0173 rizikai tur\u0117s galima s\u0105veika tarp \u0161i\u0173 vaist\u0173? Vien\u0105 i\u0161 galim\u0173 atsakym\u0173 pateikia neseniai atliktas tyrimas. Jo tyrimo metu bandyta \u012fvertinti, ar kartu vartojant PPI ir klopidogrel\u012f gali atsirasti neigiamas poveikis vyresniems pacientams, i\u0161ra\u0161ytiems i\u0161 ligonin\u0117s po \u016bminio miokardo infarkto gydymo.<\/p>\n

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PAGRINDINIAI DUOMENYS APIE TYRIM\u0104<\/p>\n

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Populiaciniame atvejo ir kontrol\u0117s tyrime dalyvavo Ontario (Kanada) gyventojai (am\u017eius \u2013 ><\/u>66 m.), kurie buvo hospitalizuoti d\u0117l \u016bminio miokardo infarkto ir po i\u0161ra\u0161ymo i\u0161 ligonin\u0117s per 3 dienas prad\u0117ti gydyti klopidogreliu, bei tie, kurie buvo pakartotinai hospitalizuoti d\u0117l \u016bminio miokardo infarkto per 90 dien\u0173 po i\u0161ra\u0161ymio i\u0161 ligonin\u0117s. Jiems vertintas nepalanki\u0173 i\u0161ei\u010di\u0173 (pakartotinio miokardo infarkto ir mir\u0161tamumo) da\u017enis per 90 dien\u0173 nuo i\u0161ra\u0161ymo (pirmin\u0117 analiz\u0117). Antrin\u0117 analiz\u0117 vertino nepalanki\u0173 i\u0161ei\u010di\u0173 da\u017en\u012f per vienerius metus. triskart didesn\u0119 kontrolin\u0119 pacient\u0173 grup\u0119 sudar\u0117 tie, kuriems ne\u012fvyko n\u0117 vieno pakartotinio miokardo infarkto per steb\u0117jimo laikotarp\u012f. PPI vartojimo pob\u016bdis buvo suklasifikuotas, atsi\u017evelgiant \u012f nepalanki\u0173 i\u0161ei\u010di\u0173 da\u017enio vertinimo dat\u0105 (90 dien\u0173 po MI): dabartinis (30 dien\u0173 laikotarpis iki vertinimo), ankstesnis (31\u201390 dien\u0173 laikotarpis iki vertinimo) ir atokusis (91\u2013180 dien\u0173 iki vertinimo) (1 pav.)<\/i>.<\/p>\n

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\u012e tyrim\u0105 nebuvo \u012ftraukiami pacientai, vartoj\u0119 klopidogrel\u012f, tiklodipin\u0105 arba dipiridamol\u012f vienerius metus iki hospitalizavimo. Taip pat \u012f tyrim\u0105 nebuvo \u012ftraukiami pacientai, kurie buvo gydomi ilgalaik\u0117s prie\u017ei\u016bros \u012fstaigose ir tie, kurie 90 dien\u0173 prie\u0161 ar po i\u0161ei\u010di\u0173 vertinimo datos vartojo PPI Helicobacter pylori<\/i> eradikacijai.<\/p>\n

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Remiantis duomen\u0173 bazi\u0173 informacija ir pagal gydymo laikymosi algoritm\u0105 nustatyta, kurie pacientai nuolatos vartojo klopidogrel\u012f. Tai pacientai, kuriems receptai buvo i\u0161ra\u0161omi laiko intervalais, nevir\u0161ijan\u010diais dien\u0173 skai\u010diaus, kuriam turi pakakti vaist\u0173, daugiau kaip 1,2 karto.<\/p>\n

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Jei pacientas d\u0117l miokardo infarkto buvo hospitalizuojamas pakartotinai daugiau nei vien\u0105 kart\u0105, buvo vertinamas tik pirmas hospitalizavimas.<\/p>\n

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1 pav. <\/b><\/span><\/i>Tyrimo planas<\/span><\/i><\/b><\/p>\n

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\"Proton\u0173<\/span><\/i><\/b><\/p>\n

Remote proton inhibitor use<\/span><\/i> \u2013 Atokusis PPI vartojimas<\/p>\n

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Previous proton pump inhibitor use<\/span><\/i> \u2013 Ankstesnis PPI vartojimas<\/p>\n

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Current<\/span><\/i> proton pump inhibitor<\/i> use<\/i> \u2013 Dabartinis PPI\u0173 vartojimas<\/p>\n

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Outcome (index)<\/span><\/i> date<\/i> \u2013 I\u0161ei\u010di\u0173 vertinimo data<\/p>\n

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Discharge date following acute myocardial infarction (prescription for clopidogrel within 3 days)<\/span><\/i> \u2013 I\u0161ra\u0161ymo i\u0161 ligonin\u0117s po \u016bminio miokardo infarkto gydymo data (receptas klopidogreliui \u012fsigyti gautas per 3 dienas nuo i\u0161ra\u0161ymo i\u0161 ligonin\u0117s)<\/p>\n

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Follow-up (maximum 90 days)<\/span><\/i> \u2013 Steb\u0117jimas (daugiausia 90 dien\u0173)<\/p>\n

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Atliekant antrin\u0119 analiz\u0119 vertintas histamino H2 receptori\u0173 antagonist\u0173 (H2-RA) vartojimas, atsi\u017evelgiant \u012f PPI vartojim\u0105 nuo i\u0161ra\u0161ymo i\u0161 ligonin\u0117s iki i\u0161ei\u010di\u0173 vertinimo datos. Atliekant antrin\u0119 analiz\u0119 terminas \u201edabartinis vartojimas\u201c buvo pakeistas. Jam buvo priskirtas PPI vartojimas nuo i\u0161ra\u0161ymo i\u0161 ligonin\u0117s iki i\u0161ei\u010di\u0173 vertinimo datos. Taip pat buvo atlikta pakartotinio miokardo infarkto da\u017enio ir mir\u0161tamumo per vienerius metus po i\u0161ra\u0161ymo i\u0161 ligonin\u0117s analiz\u0117, i\u0161tirtas H2-RA \u2013 ranitidino, famotidino ir nizatidino vartojimas. \u0160i\u0173 vaist\u0173 vartojimo klinikin\u0117s indikacijos yra pana\u0161ios kaip PPI, ta\u010diau H2-RA neslopina citochromo P450 2C19.<\/p>\n

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Siekiant patikrinti pirmini\u0173 duomen\u0173 specifi\u0161kum\u0105, analiz\u0117 pakartota kohortoje pacient\u0173, kuriems nebuvo skirta klopidogrelio per 90 dien\u0173 nuo i\u0161ra\u0161ymo i\u0161 ligonin\u0117s po miokardo infarkto gydymo. Galiausiai atlikta pakartotinio miokardo infarkto rizikos analiz\u0117, skiriant gydym\u0105o pantoprazoliu arba kitais PPI, nes \u017einima, kad pantoprazolis neslopina citochromo P450 2C19 ir tod\u0117l netur\u0117t\u0173 trikdyti klopidogrelio metabolin\u0117s aktyvacijos, o kiti PPI ir j\u0173 pirminiai metabolitai slopina \u0161\u012f citochrom\u0105, tod\u0117l tik\u0117tina, kad jie susilpnina ir teigiam\u0105 klopidogrelio poveik\u012f (13). <\/p>\n

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REZULTATAI<\/p>\n

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Per tyrimo laikotarp\u012f identifikuota 13\u00a0636 tinkami pacientai, kuriems po \u016bminio miokardo infarkto per 3 dienas skirta klopidogrelio. Vidutinis j\u0173 am\u017eius buvo 76 m. 7579 vis\u0173 pacient\u0173 (55,6 proc.) buvo vyrai.<\/p>\n

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Po i\u0161ra\u0161ymo i\u0161 ligonin\u0117s \u0161iems pacientams buvo da\u017enai skiriama PPI: 2682 (19,7 proc.) pacient\u0173 prad\u0117jo vartoti PPI per 30 dien\u0173 po i\u0161ra\u0161ymo i\u0161 ligonin\u0117s ir 4224 (31,0 proc.) \u2013 per 90 dien\u0173.<\/p>\n

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Per 90 dien\u0173 steb\u0117jimo laikotarp\u012f 734 pacientai buvo hospitalizuoti d\u0117l pakartotinio miokardo infarkto ir 2057 atvejai \u012fvardyti kaip kontroliniai. <\/p>\n

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Atlikus pirmin\u0119 analiz\u0119 buvo nustatytas stipri koreliacija tarp pakartotinio hospitalizavimo d\u0117l MI ir dabartinio PPI vartojimo (santykin\u0117 rizika 1,27, 95 proc. PI 1,03\u20131,57), ta\u010diau tokios koreliacijos su ankstesniu ar atokiuoju PPI vartojimu nenustattyta (2 pav.)<\/i>.<\/p>\n

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2 pav. Ry\u0161ys tarp gydymo skrand\u017eio sul\u010di\u0173 sekrecij\u0105 ma\u017einan\u010diais vaistais ir nepalanki\u0173 i\u0161ei\u010di\u0173<\/b><\/span><\/i><\/p>\n

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\"Proton\u0173<\/b><\/span><\/i><\/p>\n

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Dabartinis proton\u0173 pompos inhibitori\u0173 vartojimas (per 30 dien\u0173 iki i\u0161ei\u010di\u0173 vertinimo datos) kartu su klopidogreliu buvo susij\u0119s ne tik su padid\u0117jusia pakartotinio MI rizika per 90 dien\u0173, bet ir per 1 met\u0173 laikotarp\u012f nuo i\u0161ra\u0161ymo i\u0161 ligonin\u0117s. Tokio ry\u0161io nebuvo su ankstesniu gydymu PPI bei pacientams, kurie po \u016bminio miokardo infarkto nevartojo klopidogrelio. Gydymas H2 receptori\u0173 antagonistais ir pantoprazoliu nebuvo susij\u0119s su padid\u0117jusia pakartotinio MI rizika, o gydymas kitais PPI j\u0105 padidino reik\u0161mingai. Mirties rizika gydant PPI po persirgto MI ir kartu vartojant klopidogrelio, nebuvo padid\u0117jusi.<\/p>\n

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Pakeitus PPI vartojimo pob\u016bd\u017eio termin\u0105 (prapl\u0117tus dabartinio vartojimo s\u0105vok\u0105 iki 90 dien\u0173), nepalanki\u0173 i\u0161ei\u010di\u0173 rizika reik\u0161mingai nepasikeit\u0117. Kaip ir buvo tik\u0117tasi, ry\u0161io tarp pakartotinio MI ir H2-RA vartojimo nenustatyta. Visi tirti proton\u0173 pompos inhibitoriai, i\u0161skyrus pantoprazol\u012f, didino pakartotinio MI rizik\u0105 per 90 dien\u0173 nuo i\u0161ra\u0161ymo i\u0161 ligonin\u0117s iki 40 proc. (santykin\u0117 rizika 1,40, 95\u00a0proc. PI 1,10\u20131,77).<\/p>\n

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APIBENDRINIMAS<\/p>\n

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Kasmet milijonams pacient\u0173 atliekama \u0161irdies vainikini\u0173 arterij\u0173 angioplastika arba juos i\u0161tinka naujas ar pakartotinis miokardo infarktas<\/a>. Daugumai toki\u0173 pacient\u0173 po infarkto skiriamas gydymas klopidogreliu, neretai kartu paskiriama ir aspirino. D\u0117l pastarojo skrand\u017eio gleivin\u0119 dirginan\u010dio poveikio naujose Amerikos \u0161irdies asociacijos, Amerikos gastroenterolog\u0173 kolegijos ir Amerikos kardiolog\u0173 kolegijos parengtose gair\u0117se daugumai pacient\u0173, \u012fskaitant ir vyresnius nei 60 met\u0173 am\u017eiaus, si\u016blomas gydymas skrand\u017eio sul\u010di\u0173 sekrecij\u0105 ma\u017einan\u010diais vaistais (pvz., proton\u0173 pompos inhibitoriais) (17).<\/p>\n

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\u0160is tyrimas yra labai reik\u0161mingas, nes jame dalyvavo didelis skai\u010dius vyresni\u0173 nei 66\u00a0m. pacient\u0173, persirgusi\u0173 \u016bminiu koronariniu sindromu (\u016bminiu miokardo infarktu), kuriems skirtas gydymas klopidogreliu po i\u0161ra\u0161ymo i\u0161 ligonin\u0117s. Nema\u017ea j\u0173 dalis vartojo ir PPI. <\/p>\n

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Tyrimu buvo Nustatyta, kad kartu su klopidogreliu proton\u0173 pompos inhibitori\u0173 vartoj\u0119 pacientai tur\u0117jo \u017eymiai diden\u0119 pakartotinio miokardo infarkto rizik\u0105 per trump\u0105 laik\u0105 po i\u0161ra\u0161ymo i\u0161 ligonin\u0117s. Priklausomai nuo to, koks buvo PPI vartojimo pob\u016bdis (dabartinis ar ankstesnis), daugiau nei 5\u201315 proc. ankstyv\u0173j\u0173 pakartotini\u0173 hospitalizacij\u0173 d\u0117l miokardo infarkto gal\u0117t\u0173 b\u016bti klopidogrelio ir PPI s\u0105veikos pasekm\u0117. Ry\u0161io tarp atokiojo PPI vartojimo arba dabartinio H2 receptori\u0173 antagonist\u0173 vartojimo ir padid\u0117jusios pakartotinio MI rizikos nenustatyta. I\u0161 vis\u0173 analizuot\u0173 PPI galima i\u0161skirti pantoprazol\u012f, kuris taip pat nedidino pakartotinio MI rizikos.<\/p>\n

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Apibendrinant galima teigti, kad \u0161io tyrimo rezultatai palaiko hipotez\u0119, kad kai kurie proton\u0173 pompos inhibitoriai <\/span>(omeprazolis, lansoprazolis ir rabeprazolis)<\/span>, slopinantys klopidogrelio metabolizmui svarb\u0173 citochrom\u0105 <\/span>P450 2C19,<\/span> labai suma\u017eina ar net panaikina klopidogrelio kardioprotekcin\u012f poveik\u012f po \u016bminio miokardo infarkto. Tod\u0117l, esant b\u016btinybei vartoti skrand\u017eio sul\u010di\u0173 sekrecij\u0105 ma\u017einan\u010di\u0173 vaist\u0173, reik\u0117t\u0173 rinktis pantoprazol\u012f arba H2 receptori\u0173 antagonistus (ranitidin\u0105 ar pan.).<\/p>\n

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Pareng\u0117 gyd. A.\u00a0STANKEVI\u010cI\u016aT\u0116<\/p>\n

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Gauta: 2009-03-18<\/p>\n

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Pateikta spaudai: 2009-03-31<\/p>\n

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LITERAT\u016aRA<\/p>\n

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1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin<\/a> in patients with acute coronary syndromes without ST-segment elevation. <\/span>N Engl J Med <\/span><\/i>2001;345:494-502.<\/p>\n

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2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Ackman ML, Graham MM, Hui C, et al. <\/span>Effect of a prior authorization process on antiplatelet therapy and outcomes in patients prescribed clopidogrel following coronary stenting. Can J Cardiol <\/i>2006;22:1205-8.<\/p>\n

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3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Ho PM, Peterson ED, Wang L, et al. Incidence of death and acute myocardial infarction associated with stopping clopidogrel after acute coronary syndrome. JAMA <\/i>2008;299:532-9.<\/p>\n

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4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Sheehy O, LeLorier J, Rinfret S. Restrictive access to clopidogrel and mortality following coronary stent implantation. CMAJ <\/i>2008;178:413-20.<\/p>\n

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5.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Jackevicius CA, Tu JV, Demers V, et al. <\/span>Cardiovascular outcomes after a change in prescription policy for clopidogrel. N Engl J Med <\/i>2008;359:1802-10.<\/p>\n

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6.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Savi P, Pereillo JM, Uzabiaga MF, et al. Identification and biological activity of the active metabolite of clopidogrel. Thromb Haemost <\/i>2000;84:891-6.<\/p>\n

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7.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Savi P, Herbert JM, Pflieger AM, et al. <\/span>Importance of hepatic metabolism in the antiaggregating activity of the thienopyridine clopidogrel. Biochem Pharmacol <\/i>1992;44:527-32.<\/p>\n

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9.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Simon T, Verstuyft C, Mary-Krause M, et al. <\/span>Genetic determinants of response to clopidogrel and cardiovascular events. N Engl J Med <\/i>2009;360:363-75.<\/p>\n

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\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

Neseniai paskelbtose gair\u0117se daugumai pacient\u0173, gydyt\u0173 aspirinu po \u016bminio miokardo infarkto, si\u016bloma skirti PPI (17). Dauguma \u0161i\u0173 pacient\u0173 taip pat vartos ir klopidogrel\u012f. Taigi, tik\u0117tina, kad milijonai pacient\u0173 visame pasaulyje vartos PPI ir klopidogrelio derin\u012f. Koki\u0105 \u012ftak\u0105 nepalanki\u0173 kardiovaskulini\u0173 i\u0161ei\u010di\u0173 rizikai tur\u0117s galima s\u0105veika tarp \u0161i\u0173 vaist\u0173? Vien\u0105 i\u0161 galim\u0173 atsakym\u0173 pateikia neseniai atliktas tyrimas. Jo tyrimo metu bandyta \u012fvertinti, ar kartu vartojant PPI ir klopidogrel\u012f gali atsirasti neigiamas poveikis vyresniems pacientams, i\u0161ra\u0161ytiems i\u0161 ligonin\u0117s po \u016bminio miokardo infarkto gydymo.<\/o:p><\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[1661,93,7,758,243,1387,760,138],"site":[],"post_item_type":[27345],"class_list":["post-12737","post","type-post","status-publish","format-standard","hentry","tag-gydymas-klopidogreliu","tag-infarktas","tag-inhibitoriai","tag-kraujagysliu-sistemos","tag-ligonines","tag-santykine-rizika","tag-sirdies-kraujagysliu-sistemos","tag-vaistai"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/12737","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=12737"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/12737\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=12737"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=12737"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=12737"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=12737"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=12737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}