Chirwere , kana kusava neropa kuvhara , inowanzova mungozi yakawanda inobereka miviri miviri yezvinetso zvezvehutano.
Chokutanga, kuputika mukati meyeri kunogona kudzivisa kukwira kweropa, kuunza kukanganisa kune nhengo dzinowanikwa neyeri yakavharidzirwa. Myocardial infarctions (kurwadziwa kwemoyo) kazhinji kunosanganisira kuputika mukati megoni , uye kushungurudzika kweplates kunokonzerwa nehupusiki mune imwe yemapuiti anopa uropi.
Chechipiri, kushungurudzika kunowanikwa mukati moutsi kana mukati memwoyo kunogona kuvhara . Izvozvo zvinoreva kuti ropa rinoputika rinogona kuputika nekufamba nenzira yeropa, kuita zvinokuvadza kupi zvako kwaunopinda. Chirwere chemapurmoni chinokonzerwa neropa rinopinza kumapapu (kazhinji, kubva mumupfu muhudyu). Embolic strokes inokonzerwa neropa rinopfuurira kuuropi, kazhinji kubva kune-thrombus mukati memwoyo, kazhinji kanobatanidzwa neArial fibrillation .
Zvinodhaka Zvinodzivirira kana Kuita Ropa Ropa
Vanhu vari pamatambudziko akakwirira ekudzikisa hutachiona hunopisa hunowanzodikanwa kurapwa kana kudzivirira kuti chirwere ichi chisati chaitika kana kuedza kuputsa ropa rinenge rave rakagadzirwa. Kune zvikamu zvitatu zvakasiyana siyana zvezvinodhaka izvo zvinowanzoshandiswa kudzivirira kana kubata chirwere chetreatis - anticoagulant madhiragi, mishonga ye fibrinolytic, uye anti antiplatelet.
Nepo imwe neimwe yemishonga iyi ine purogiramu yake yemigumisiro yakaipa, imwe yechirwere inowanikwa kune vose inopfuvura ropa.
Saka zvose izvi zvinodhaka zvinofanira kushandiswa nekuchengeteka kwakakodzera.
Anticoagulant Zvinodhaka
Iyo anticoagulant zvinodhaka inobvisa chimwe kana zvimwe zvezvinhu zvinodzivirira . Kuvhara zvinhu ndeboka reprotein yeropa iro rinokonzera kuvhara ropa.
Aya madhiragi anosanganisira:
Heparin. Heparin imishonga inopinza iyo ine nguva pfupi (mumaminitsi mashoma) inhibitory effect pamadziro ekuvhara.
Vanachiremba vanogona kugadzirisa dhiyo yavo nguva dzose, sezvinodiwa, kuburikidza nekucherechedza chirwere cheprombo cheputiplastin (PTT) yeropa . Iko PTT inoratidza kuti zvinhu zvakavharidzirwa zvakadziviswa sei. (Ndiko kuti, inoratidza "kuderera" kweropa.) Heparin inoshandiswa chete muzvipatara varwere.
Low Molecular Weight Heparin: enoxaparin (Lovenox), dalteparin (Fragmin). Iyi mishonga inonatswa kubva kune heparin. Kubudirira kwavo kukuru pane heparin ndechokuti vanogona kupiwa seganda rejekisi (iyo inenge inoda munhu wose angadzidza kuita mumaminitsi mashomanana) panzvimbo yechirwere, uye haafaniri kuongororwa zvakanyanya neropa rekuongorora. Saka, kusiyana ne heparin, inogona kutarisirwa nehukama hwakachengetedzeka pamusana pepfungwa.
Zvitsva Intravenous or Subcutaneously-Inotarisirwa Anticoagulant Zvinodhaka. Akawanda "heparin-like" anticoagulant mishonga yakagadzirwa, kusanganisira argatroban, bivalirudin (Angiomax), fondaparinux (Arixtra) uye lepirudin (Refludan). Nguva yakakodzera uye nzvimbo yekushandisa madhiragi aya ose ari kuendeswa mberi zvishoma nezvishoma.
Warfarin (Coumadin). Kusvikira munguva pfupi yapfuura, warfarin ndiyo chete yemuromo yakarongedzwa anticoagulant mishonga inowanikwa.
Dambudziko guru re warfarin rave riri mukugadzirisa kuyerwa kwayo.
Pakutanga kutorwa, chirwere chefarfarin chinofanira kugadziriswa pane imwe nguva yemavhiki uye kuongororwa kweropa kakawanda (INR test blood). Kunyangwe mushure mekusimudzira INR ichiri kudikanwa kuongororwa nguva nenguva, uye muyero we warfarin inowanzodikanwazve kugadziriswa. Saka, kusvika nekuchengetedza chirongwa che "zvakanaka" che warfarin chagara chiri chakaoma uye chisingaiti.
"Mutsva" Oral Anticoagulant Zvinodhaka - The NOAC Zvinodhaka. Nemhaka yekuti chirwere chakakwana che warfarin chinogona kunge chakaoma kutarisira, makambani emishonga akashanda kwemakore kuti ave ne "warfarin-substitutes" - kureva, anticoagulant zvinodhaka zvinogona kutorwa nomuromo.
Zvine zveyi idzva remuromo anticoagulant zvinodhaka (iyo mishonga yaNoAC) ikozvino yakagamuchirwa.
Aya ndiwo dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), uye edoxaban (Savaysa). Iyo yakakosha miviri yemishonga iyi ndeyokuti inogona kupiwa muhutachi hwemazuva ose, uye haitarisirwi kuongorora ropa kana kuchinja kweiyo. Zvisinei, sezvakangoita nemishonga yose, kune zvakashata kusvika kune zvinodhaka zveNoAC .
Fibrinolytic Zvinodhaka
Streptokinase, urokinase, alteplase, reteplase, tenecteplase. Iyi mishonga ine simba inopiwa zvakajeka uye zvakasimba kuti iparadze ropa rinenge riri mukugadzira. Kune chikamu chikuru, kushandiswa kwavo kunongogumira kune varwere vari mukati maawa mashomanana ekutanga kwekurwadza kwepfungwa kana kurwadza, uye vanopiwa mukati maro kuti vaedze kuzarura ariti yakavharidzirwa uye kudzivirira kusagadzikana kwechigunwe chemashuga.
Mishonga inonzi fibrinolytic (iyo inowanzonzi "bhatter clot"), inogona kuva yakaoma kushandisa. uye vanotakura dambudziko guru rekubuda ropa. Zvisinei, mumamiriro ezvinhu akanaka, kushandiswa kwemishonga iyi kunogona kudzivirira kufa kana kuremara kubva pakurwisa kwepfungwa kana kurohwa. Pamusoro pemishonga ye fibrinolytic, streptokinase inoshandiswa kakawanda pasi rose, nokuti inenge isina mari. MuUnited States, tenecteplase iye zvino ndiyo mishonga yekuzvisarudzira nokuti inoita seinoita kuti pasave nemigumisiro inokonzera kubuda ropa, uye zviri nyore kutonga kupfuura mamwe mishonga iri muboka iri.
Anti-Platelet Zvinodhaka
Mapoka matatu emishonga anoshandiswa kuderedza "kuvimbika" kweplatelets , zvinyorwa zviduku zveropa zvinoumba nucleus yeropa clot. Nokudzivisa kukwanisa kweplatelet kuti iwirirane pamwe chete, mishonga inorwisa-platelet inodzivisa kuvhara ropa. Iyi mishonga inonyanya kushanda mukudzivirira ropa risina kuchena kubva pakugadzira mishonga uye haina kunyanya kushanda pakudzivirira hutachiona mumasuru.
Aspirin uye dipyridamole (Aggrenox). Iyi mishonga inogadzikana pamaplatelet "stickiness" asi inokonzera kuderera kunokonzera ropa kunokonzera zvinosvibisa kune imwe mishonga inorwisa-platelet. Zvinowanzoshandiswa mukuedza kuderedza dambudziko rekurwadziwa kwemoyo kana kuparadzaniswa kune vanhu vane ngozi yapamusoro.
Ticlopidine (Ticlid), clopidogrel (Plavix) uye prasugrel (Mhinduro). Iyi mishonga inowedzera simba (uye naizvozvo riskier) kupfuura aspirin uye dipyridamole. Iyo inowanzoshandiswa kana njodzi yekugadzirisa kubata iri yakakwirira zvikuru. Basa ravo rinowanzoshandiswa kune vanhu vakagamuchira maronary artery stents . Kushandiswa kwavo pamusoro pemashizha - kunyanya, zvisarudzo nezvenguva yakareba yekuzvishandisa- zvakakakavadzana .
IIb / IIIa Inhibitors: abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat). I IIb / IIIa inhibitor zvinodhaka ndiro boka rakasimba kwazvo re platelet inhibitors. Inhibit receptor pamusoro peplatelets (iyo inonzi inonzi IIb / IIIa receptor) iyo inokosha pakubatanidzwa kweplatelet. Kunyanya kushandiswa kwavo ndekudzivirira kuvhara kwemaawa mushure mekupindira maitiro (zvakadai seangioplasty uye stent placement), uye kune varwere vane acon coronary artery syndrome . Iyi mishonga inodhura zvikuru uye (inowanzo) inofanira kupiwa intravenously.
Shoko Rinobva
Mishonga yakawanda iri mumakiriniki ekushandisa kubatsira kudzivirira kana kubata ropa. Vane nzira dzakasiyana dzekuita, zviito zvakasiyana, uye zvinoshandiswa pasi pemakiriniki akasiyana-siyana. Kushandisa chero ipi zvayo yemishonga iyi nguva dzose inotakura njodzi yekubuda ropa kusina kujairika, uye inofanira kushandiswa chete kana zvikomborero zvingangove zvisingakwanisi kuisa njodzi idzi. Kana uchitarisira kugadzirisa, zvakakosha zvikuru kuti chiremba asarudze mishonga yakakodzera, pasi pemamiriro akanaka.
> Sources:
> Franchini M, Mannucci PM. New Anticoagulants in Internal Medicine: Update. Eur J Intern Med 2010; 21: 466.
> Kearon C, Akl E, Omelas J, et al. Antithrombotic Therapy yeVTE Disease. CHEST Guideline uye Gweta rePanisi rePanisi. Bofu 2016; 149: 315.
> Weitz JI, Hirsh J, Samama MM, American College of Chest Physicians. Zvinyorwa zvitsva zvinodhaka: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 234S.