IA NOAC zvinodhaka - vatsigiri veCoumadin
Kana iwe ukatarisa chero terevhizheni, maitiro iwe wakanga uchiona zvikwereti zvekutsvaga anticoagulant zvinodhaka (ropa rakanyanyisa) rinonzi Pradaxa, Eliquis, Xarelto, uye Savaysa. Zvitengesheni zvinoreva kuti mishonga iyi iri nyore kutora, yakachengeteka, uye inoshanda seyobudiriro (kana isiri yakanyanya) kupfuura Coumadin (warfarin).
Kunyange zvazvo izvi zvichiti hazvina musoro, havatauri nyaya yose.
Zvinetso naCoumadin
Kune varwere vanoda kutora anticoagulant zvinodhaka (somuenzaniso, vanhu vane acrial fibrillation , deep deep thrombosis , kana pulmonary embolus ), kwemakore mazhinji chete nzira yakanakisisa yakasarudzwa yaiva Coumadin.
Kushandisa Coumadin zvakachengeteka uye zvinobudirira kunogona kuva dambudziko rechokwadi. Izvi zvinowanzodiwa kuti uve nenguva yekuedza kuongororwa ropa kuti uenzane nemafungiro ekugadzirisa ("kuonda" kweropa), uye kugadziriswa kwemajairo kakawanda kunowanzodiwa kuti uchengetedze mamiriro ekugadzirisa mumamiriro akarurama. Kuchinja kwehutano, uye kunyange kudya zvokudya zvisina kunaka, kunogona kuita kuti ropa "rive rakatetepa" (iro rinogona kuwedzera njodzi yekubuda ropa rakawandisa), kana kuti kwete "shoma zvakakwana" (iyo inogona kuwedzera ngozi yeropa). Pakupedzisira, kutora Coumadin kunenge kusina kunaka.
Mishonga inowanikwa mune dzose idzi dzinotengeswa dzinobva mune imwe boka remazana emishonga iyo, mune varwere vakawanda, inopa imwe nzira kune Coumadin. Vanachiremba vanowanzotaurira mishonga iyi seAOACs - "inobudisa manzwi anticoagulants."
Maitiro aNoACs Anoshanda
Anticoagulant zvinodhaka zvinoshandiswa nekudzivisa kubatana kwezvinhu (inonziwo clotting factors) muropa. Kuvhara zvinhu zvinoita mapuroteni anoshanda pamwe chete nemaplatelets eropa ekubudisa ropa.
Coumadin inoshanda nekudzivisa vitamini K, vitamini inofanirwa kubudiswa kwezviverengero zvakakosha zvinovhara.
Kutaura zvazviri, kupa vitamin K inzira inobatsira yekudzosera zvakashata zvinoitwa neCoumadin.
I-NOACs inoshanda nekudzivisa zvakananga kuvhara zvinhu. Pradaxa (dabigatran) inhibits directly thrombin, inonziwo clotting factor IIa.
Imwe iyo inowanika yeA NOACs - Xarelto (rivaroxaban), Eliquis (apixaban), uye Savaysa (edoxaban) - basa nekudzivisa kusiyana kwakasiyana-siyana, factor Xa.
Chii Chinogadzira NOACs "Zviri nani" Kupfuura Coumadin?
I-NOACs inobatsira zvikuru kupfuura Coumadin. Izvozvi, zvinounza anticoagulant yakagadzikana nemitambo yakakwana, saka hapana kuongororwa kweropa kana kuchinjwa kweiyo kudiwa. Uye hapachina zviratidzo zvekudya zvine chokuita nokutora NOACs. Nokudaro kutora NOACs kunowanzova kunopesana zvikuru muupenyu hwemunhu pane kutora Coumadin.
Uyezve, zvidzidzo zvekurapa zvinoratidza kuti maNoACs anoshanda seCoumadin mukudzivirira ropa. Uye njodzi yekurwadziwa kukuru kweAIDS neA NOACS inenge isiri yakakwirira kupfuura Coumadin (uye inogona kunge yakaderera).
Ndezvipi Zvakakonzera KuNoacs?
Zvichida mutsauko mukuru ndewokuti, kusiyana neCoumadin, hapana antidote iripo zvino kune zvitatu zvemishonga iyi kuti ichinje kushandura mafungiro avo anticoagulant.
Izvi zvinoreva kuti kana chiitiko chekubuda ropa chichiitika, chiitiko chemugumo wakaipa ungave wakakwirira kudarika neCoumadin.
MunaOctober, 2015, FDA yakabvumira mushonga mutsva Praxbind (idarucizumab) kuti adzore migumisiro ye Pradaxa. Iko kuwanikwa kwehutachiona hwePradaxa inokosha inokurudzirwa.
Zvisinei, kubva kune imwe inowanikwa maNowa mishonga inodzivisa chinonzi Xa, uye kwete chikonzero IIa sePradaxa, Praxbind haachidzori migumisiro yavo. Antidotes kune chinonzi Xa inhibitors iri kuumbwa.
Pradaza naEriquis vanoda kaviri pazuva, musingafani neXarelto uye Savaysa (uye Coumadin) inongotorwa chete kamwe chete pazuva.
I-NOACs inodhura zvikuru kupfuura Coumadin, uye mari inogona kunge isina kukodzera vanhu vane inshuwarisi isingavavha.
I-NOACs haibvumirwi kune dzimwe shanduro, somuenzaniso, kune varwere vane mavheti emwoyo mavanga kana vane mimba.
Iyi mishonga inonyanya kushandiswa neitsvo, uye inoda kushandiswa nekuchenjerera kukuru, kana zvachose, kune varwere vane chirwere chepvo.
Pakupedzisira, sezvo maCONACs ari madzimai matsva, zvinokwanisika kuti zvimwe, zvino zvisingabvumirwi nemigumisiro inogona kuonekwa. (Ichi ndicho chinotyisa munhu anotora, zvirokwazvo, nemumwe mushonga mutsva.)
Ndeipi Inofanira Kuitwa NAKAC?
Kutaura chokwadi, uyu mubvunzo uyo nyanzvi dzezvechiremba dziri kungobuda kunze. Asi nekuda kwematambudziko anozivikanwa eCoumadin, nyanzvi dzakawanda dzinoramira zvakasimba zvakasimba kurumbidza hutsva anticoagulant zvinodhaka sechisarudzo chekutanga kune vanhu vakawanda vanoda kusingaperi an oraloagulation.
Shoko Rinobva
Mishonga yeCONAC inopa nzira yakakwana kune vanhu vanoda chirwere chisingaperi chine antiticoagulation, uye kune vakawanda, iyo inosarudzwa.
Vanhu vangave vachiwana vanachiremba vachirumbidza imwe yemishonga mitsva kana iri kutangwa paanticoagulation kwekutanga, kana vakave vakaoma kuchengetedza chiitiko chakachengetedzeka cheCoumadin, kana kana (mushure mokuteerera zvingangova nengozi uye zvinobatsira yezvisarudzo zvose) ivo pachavo vanobudisa pachena zvakajeka kune mishonga mitsva. Kune rumwe rutivi, vanhu vanga vari kutora Coumadin kubudirira - nekuchengetedza ropa kuongororwa pamutengo wakadzikama - kwemwedzi mishomanana kana yakareba zvichida zviri nani pakunamatira neCoumadin.
> Sources:
> Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran Versus Warfarin Muvarwere Vane Fibrillation yeAreria. N Engl J Med 2009; 361: 1139.
> Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban Versus Warfarin In Nonvalvular Atrial Fibrillation. N Engl J Med 2011; 365: 883.
> Granger CB, Alexander JH, McMurray JJ, et al. Apixaban Versus Warfarin Muvarwere NeArper Fibrillation. N Engl J Med 2011; 365: 981.
> Furie KL, Goldstein LB, Albers GW, et al. Oral Antithrombotic Agent for Prevention of Stroke in Nonvalvular Atrial Fibrillation: A Inyanzvi yeSayenzi yeVashandi Vezvehutano Kubva kuAmerican Heart Association / American Stroke Association. Stroke 2012.