Anticoagulants ncaj thiab indirect kev txiav txim. Indirect anticoagulants: daim ntawv ntawm cov tshuaj, lub mechanism ntawm qhov kev txiav txim, cais. Overdose indirect anticoagulants

Nrog cov hauj lwm ntawm coagulation thiab cov ntshav systems antisvertyvayuschey normalization hauv cov tshuav nyiaj li cas hauv lub cev. ntshav khiav los ntawm cov hlab ntsha tsis muaj teeb meem thiab xyuas, thiab thrombus tsim ntawm qhov tseeb lawm. Thaum qhov nqi koj tshuav yog ntxhov hauj lwm ntawm systems nyob rau hauv dej siab ntawm cov ua kom cov ntshav coagulation, muaj tej yam kev mob uas yuav ua rau ntev li tsim ntawm txhaws. Indirect anticoagulants - ib qho ntawm cov pab pawg ntawm cov tshuaj siv rau rov qab los ntawm Internal kev ntshawv siab.

Yuav ua li cas yog anticoagulants?

Anticoagulant hu ua nyiaj, uas muaj anticoagulant nyhuv thiab activates lub dilution ntawm cov ntshav. Qhov no tso cai rau koj los lub rheological yam ntxwv thiab txo thrombosis.

Txhais tau tias yog muaj nyob rau hauv cov ntsiav tshuaj daim ntawv no, raws li tshuaj pleev, cov gels thiab txhaj tshuaj preparations. Lawv muab tsis tau tsuas yog rau kev kho mob, tab sis kuj yuav tiv thaiv kom txhob nce tsim ntawm cov ntshav txhaws.

Feem ntau cov mej zeej ntawm lub pab pawg neeg ntawm cov tshuaj yog tsis tsim thrombus, thiab txhaws kev ua si. Tus txheej txheem ntawm raug ntshav yam, thiab zus tau tej cov thrombin, uas slows cia cov ntshav txhaws.

Tshuaj yog muab faib ua ob pawg raws li lawv cov kev ua ub:

• ncaj anticoagulants;
• indirect anticoagulants.

ncaj kev txiav txim ntawm heparin-raws li tshuaj

Qhov no pab pawg neeg ntawm cov nyiaj muaj ib tug ncaj qha ntxim rau cov ntshav cofactors uas inhibit thrombin. Lub ntsiab tus neeg sawv cev yog heparin. Nyob rau qhov no vim muaj ib tug xov tooj ntawm cov tshuaj yeeb yam zoo sib xws thiab tsiaj ntawv nrog lub npe:

• "Ardeparin".
• "Nadroparin."
• "Klivarin".
• "Longiparin".
• "Sandoparin".

Heparin los yog derivatives khi rau antithrombin-III, uas ua rau yus mus rau ib tug kev hloov nyob rau hauv lub qhov chaw ntawm nws molecules. Qhov no speeds cov kev twb kev txuas ntawm ib tug cofactor rau thrombin, thiab ces mus rau inactivate lub txhaws txheej txheem.

Nta ntawm daim ntawv thov "heparin"

Action tshuaj tswj tiv thaiv cov kev loj hlob thiab kis ntawm ib tug ntshav los khov rau ntawd. Heparin molecules tsim tau ib txoj nrog antithrombin, uas yog ib qho inhibitor ntawm coagulation yam. Cov tshuaj yeeb dej caw yog ib tug glycosaminoglycan saw. Cov tshuaj no yog txhaj subcutaneously thiab pib qhov kev txiav txim tom qab ib tug ob peb teev.

Yog hais tias tsim nyog, ceev kev txiav txim "heparin" Txoj kev lis ntshav muab intravenously leeb kev ua tau zoo thiab ua rau kom bioavailability. Qhov kev xaiv ntawm cov tshuaj ntau npaum nyob rau hauv lub xeev nyob rau hauv uas tus neeg mob nyob. Ntxiv mus, coj mus rau hauv tus account lub xub ntiag ntawm concomitant kab mob, thaum uas tig mus thawj coj ntawm lwm pab pawg neeg ntawm medicaments, qhov yuav tsum tau rau kev phais cov txheej txheem rau cov hlab ntsha.

oligopeptides

Cov tshuaj uas ua ncaj qha rau ntawm qhov chaw ntawm thrombin kom, pom tau hais tias muaj zog cov kev inhibitors ntawm thrombosis system. Lub active ingredient ntawm cov tshuaj nyob rau hauv lawv tus kheej txuas mus rau lub txhaws yam, hloov lawv zoo.

Cov tshuaj no "inogatran", "Hirudin", "Efegatran", "Tromstop" thiab lwm tus neeg. Siv los mus tiv thaiv lub plawv tuaj ntawm angina, varicose kab mob, rau kev tiv thaiv ntawm thromboembolism, reocclusion thaum lub sij hawm angioplasty.

Indirect anticoagulants (daim ntawv teev)

Tus thawj anticoagulant tau txais nyob rau hauv lub XX xyoo pua nyob rau hauv lub tebchaws United States, thaum nws twb tshwm sim ib tug mob tshiab ntawm nyuj, provoking hnyav los ntshav. Thaum qhov ua tau elucidated pathological mob, nws muaj pov thawj hais tias nyob rau hauv cov tsiaj mob pwm ua clover, nyob rau hauv lub pub. Los ntawm no nyoos ntaub ntawv uas twb tsim los ntawm tus thawj tshuaj antiplatelet indirect txiav txim - "Dicoumarol".

Rau hnub tim, daim ntawv teev cov cuab tam uas yog analogs ntawm ntau tshaj ib puas yam khoom. Tag nrho cov ntawm cov tshuaj - qhov ncauj anticoagulants. Lub mechanism ntawm qhov kev txiav txim ntawm ib pab pawg neeg ntawm cov tshuaj raws li rau inhibition ntawm cov kev txiav txim ntawm vitamin K.

Muaj txhaws yam tseem ceeb uas nyob ntawm seb qhov no vitamin. Indirect anticoagulants inhibit ua kom cov coagulation cov nqaijrog thiab cofactors vitaminozavisimyh. Lub uncontrolled siv cov tshuaj yog txwv tsis pub, raws li yog nce txoj kev pheej hmoo ntawm los ntshav teeb meem.

Muaj ob lub ntsiab pawg, uas yog muab faib tag nrho indirect anticoagulants. Suam ntawm cov nyiaj yog raws li nyob rau active tshuaj muaj nyob rau hauv cov kev npaj. paub qhov txawv:

• coumarin derivatives;
• raws li cov cuab yeej indandiona.

npaj indandiona

Tom qab nqa tawm ib tug loj tus naj npawb ntawm cov kev tshawb fawb, zaum pom tias cov khoom raws li nyob rau hauv no active tshuaj yuav tsum tsis txhob yuav siv nyob rau hauv txoj kev kho. Lub formulations muaj ib tug xov tooj tseem ceeb ntawm tshwm sim raws li kev tsis haum. Cov hauj lwm zoo tej yam rau protivosvertyvaniya system kuj tsis qhia raws li tau.

Qhov no pab pawg neeg ntawm cov tshuaj muaj xws li tshuaj, "phenindione", "Difenindion", "Anisindion". Nws tau txiav txim kom tsis txhob thawj xaiv rau lub thib ob pab pawg neeg ntawm antiplatelet neeg thiab ntawm derivatives indandiona tam sim no tsuas siv "Fenilin".

Cov tshuaj muaj ib tug uas tsis muaj nqi, nws yog muaj nyob rau hauv cov ntsiav tshuaj daim ntawv. Siv tau rau 10 xuaj moos, thiab nws yog ib qho tseem ceeb heev kom muaj lub xav ntev ntawm txoj kev kho. Cov nyhuv yog tiav tsuas yog tom qab 24 teev los ntawm lub sij hawm thawj koob tshuaj. Daim ntawv thov no tshwm sim los ntawm txoj kev saib xyuas tus mob ntawm tus neeg mob ntawm cov ntshav ntawm laboratory tsis (coagulation, kev ntsuam xyuas, biochemistry).

Lub tswvyim ntawm lub 'fenilina ":

1. Thawj hnub - 1 ntsiav tshuaj 4 lub sij hawm.
2. Qhov thib ob hnub - 1 ntsiav tshuaj 3 zaug.
3. Tus so ntawm cov kev kho mob - 1 lub tshuaj ib hnub twg.

Tshuaj yuav tsum tau coj nrog rau cov tshuaj uas txo cov theem ntawm qab zib nyob rau hauv lub cev.

coumarin derivatives

Coumarin - ib yam khoom uas uas yog nyob rau hauv cov nroj tsuag thiab yuav tau ua synthetically nyob rau hauv cov kev kuaj. Ua ntej, tom qab nws tshem tawm, lub cuab tam yog siv raws li ib tug tshuaj lom nas. Tsuas yog cov zaj uas lub sij hawm pib mus thov cov tshuaj yuav kam nrog ntev thrombosis.

Anticoagulants ntawm indirect txiav txim - npaj raws li coumarin - sawv cev los ntawm cov hauv qab no txhais tau tias cov tshuaj:

• "Warfarin" (nws analogues - "Marevan" "Sodium warfarin", "Varfareks").
• "Atsenokumarola" (analogue - "Sinkumar").
• "Neodikumarina" (analogue - "Etilbiskumatsetat").

"Warfarin": daim ntawv thov nta

Anticoagulants ntawm indirect kev txiav txim (daim ntawv no muaj nyob rau hauv tsab xov xwm) yog feem ntau sawv cev los ntawm "warfarin". Qhov no txhais tau tias tableted, manufactured los ntawm 2,5, 3 los yog 5 mg. Nyhuv rau tib neeg kab muaj tom qab 1.5-3 hnub tom qab thawj zaug thawj coj ntawm cov ntsiav tshuaj. Maximum nyhuv los ntawm tus kawg ntawm lub thawj lub lim tiam.

Tom qab noj cov tshuaj lub rheological tsis ntawm cov ntshav rov qab mus rau li qub tom qab 5 hnub ntawm hnub tim uas tshem tawm "ntawm warfarin." Txhais tau tias siv 2 lub sij hawm ib hnub twg, nyob rau ib thiab tib lub sij hawm. Nyob rau sis thib 5 ntawd hnub ntawm txoj kev kho yog khij cov ntshav tsis mus txiav txim qhov feasibility thiab miv nyuas siv zug.

Hoob no ntawm kev kho mob yog xaiv cov kws nyob rau hauv txhua rooj plaub zuj zus. Tej yam kab mob kas (e.g., atrial fibrillation) yuav tsum tau tas mus li daim ntawv thov. Nrog rau txoj kev loj hlob ntawm PE (pulmonary embolism) antiplatelet neeg sawv cev yog tsis muab rau tsawg tshaj li rau lub hlis los yog rau lub neej.

Thaum qhov yuav tsum tau rau kev phais kev pab "warfarin" mus rho 5 hnub ua ntej rau kev phais. Qhov no yuav tso cai rau cov ntshav indices rov qab mus rau qub. Nrog ib tug siab xav tau mus ntxiv siv cov anticoagulant txoj kev kho, lub cuab tam yog hloov unfractionated heparin. Qhov kawg koob twb muab 4 teev ua ntej kev cuam tshuam.

Tom qab lub lag luam los ntawm 4 chasa reintroduced unfractionated heparin. Tau txais indirect antiplatelet agents yuav raug xa rov qab nyob rau hauv ob hnub, tom qab saib xyuas hauv lub xeev ntawm cov ntshav nrog kev pab los ntawm laboratory kev ntsuam xyuas.

Nyob rau hauv uas tus neeg mob yog siv anticoagulants?

Direct thiab indirect anticoagulant siv rau kev tiv thaiv ntawm thromboembolism, mob thrombosis ntawm lub venous system nyob rau hauv cov kev tshwm sim ntawm ib tug txhua yam prosthetic lub plawv li qub thiab atrial fibrillation.

Lub ntsiab kab mob nyob rau hauv txoj kev loj hlob ntawm cov uas raug anticoagulants ncaj thiab indirect txiav txim, muaj cov nram qab division rau hauv pab pawg:

1. Thrombosis ntawm lub arterial system:
   • myocardial infarction;
   • pulmonary embolism;
   • stroke nrog cov tsos mob ntawm ischemia;
   • puas raug mob rau cov hlab ntsha tiv thaiv atherosclerosis.
2. Disseminated intravascular coagulation :
   • shock lub xeev;
   • puas raug mob;
   • txoj kev loj hlob ntawm sepsis.
3. Mob thrombosis ntawm cov leeg by:
   • ntshav txhaws nyob rau hauv lub keeb kwm yav dhau ntawm varicose leeg;
   • thrombosing hemorrhoidal venous plexus;
   • los khov rau ntawd nyob rau hauv lub ua tsis tau zoo vena cava.

ntsiab contraindications

Indirect anticoagulants - yeeb siv tshuaj uas txwv tsis pub nyob rau hauv lub xub ntiag ntawm lactose tsis muaj peev xwm, malabsorption ntawm piam thaj thiab galactose. Muaj ib tug xov tooj ntawm cov tshuaj nyob rau tib lub sij hawm uas koj siv tsis tau qhov ncauj anticoagulants. Daim ntawv teev cov tshuaj uas muaj nonsteroidal anti-inflammatory siv tshuaj, "aspirin", "Dipyridamole", "clopidogrel", "penicillin", "chloramphenicol", "Cimetidine".

Tej yam kev mob uas yuav siv tsis tau anticoagulants ncaj thiab indirect txiav txim:

• ulcerative cov kab mob ntawm tus mob huam;
• vascular aneurysm;
• daim siab mob;
• mob ntshav;
• thrombocytopenia;
• raum tsis ua hauj lwm;
• Kuv peb lub hlis thiab lub hli tas los ntawm cev xeeb tub;
• theem ntawm creatinine.

Tshwm sim los ntawm cov neeg ua hauj antiplatelet

Txhua yam ntawm cov tshuaj nyob rau hauv pab pawg neeg no ntawm cov kab mob muaj xws li cov kev phiv. Lawv manifest lawv tus kheej los ntawm nws tus kheej los yog kev tshuaj los yog ua txhaum nyob rau kev siv ntawm cov tswv yim.

Sab los muaj xws li cov kev loj hlob ntawm los ntshav, dyspeptic tsos mob li ntuav, xeev siab thiab raws plab. Muaj yog ib tug muaj zog lub plab mob, allergic pob liab vog rau lub hom ua xua los yog eczema. Tej zaum tsim necrosis, plaub hau poob, daim tawv nqaij khaus.

Ua ntej yuav pib kev kho mob, tus neeg mob yuav tsum xeem dhau ib tug series ntawm kev ntsuam xyuas los mus txiav txim seb puas yuav siv cov tshuaj no. Tus neeg mob yuav muab kev pab ib tug tag nrho cov ntshav count, biochemistry, urinalysis, zis rau Nechiporenko, coagulation. Nws kuj pom zoo ua ib qho kev ultrasound kev soj ntsuam ntawm ob lub raum thiab kis tau quav rau Occult ntshav.

Overdose indirect anticoagulants

Overdoses ntawm no pab pawg neeg ntawm cov tshuaj yog heev tsis tshua muaj. Qhov no yuav tshwm sim yog tias ib tug me nyuam me me yuav tsev tshuaj thiab sim nws rau saj. Feem ntau, lub concentration ntawm cov tshuaj yeeb dej caw yog tsawg tsawg, yog li ib koob tshuaj ntsiav tshuaj tsis ntshai. Nyob rau hauv cov ntaub ntawv ntawm tshwj xeeb los yog nce siv ntawm loj koob tshuaj ntawm cov tshuaj yeeb dej caw yuav tsim ib tug coagulopathy thiab los ntshav.

overdose lub tsev kho mob muaj tsis muaj ib yam mob, yog li twv dab tsi tshwm sim haus loj nyiaj ntawm cov tshuaj, nws yog ib qhov nyuaj. Symptomatology zoo xws li cov ces nrog ntau yam kab mob thiab pathological lub xeev ntawm tus kab mob. Tus neeg mob muaj:

• teeb doog ntawm daim tawv nqaij;
• ntshav nyob rau hauv cov zis los yog quav;
• uterine los ntshav;
• hematoma nyob rau hauv lub caj dab;
• intracranial hemorrhage.

Nyuam qhuav pib, yav dhau los stroke, cov neeg laus cov neeg mob, hnyuv los ntshav thiab ib tug keeb kwm ntawm tsawg hematocrit - hais txog yam uas yuav txo tau cov nyhav ntawm lub chaw pib concentration ntawm cov tshuaj.

Antiplatelet txoj kev kho overdose

1. Ntxuav los yog miv yaug los ntawm lub plab ob peb teev tom qab thawj coj ntawm cov tshuaj muaj tsis muaj ntsiab lus.
2. Tus neeg mob yog muab tshuab txais hluav ncaig rau plab hnyuv haum.
3. "Cholestyramine" hauv muab nyob rau hauv cov ntaub ntawv ntawm "warfarin" overdose los yog nws analogues.
4. Tus neeg mob yog muab tso rau hauv antitravmaticheskie tej yam kev mob, yuav tsum tsis txhob rov tshwm sim ntawm tshiab hematomas thiab hemorrhages.
5. Nrog ntau yam pauv loj ntshav poob los yog transfusions nqa ntshav tsim ntsiab, tej zaum tag nrho cov ntshav. Npaum nyob rau hauv lub siv tau ntim cov ntshav liab, cryoprecipitate, prothrombin complex.
6. Taw "Phytomenadione" khoom raws li vitamin K.
7. Yog hais tias tsim nyog, muab tsis muaj antiplatelet txoj kev kho, cov tshuaj "Phytomenadione" tsa cov hoob kawm ntawm kev kho mob, es tsis raws li ib tug thawj pab.

Yog hais tias tus neeg mob tus mob rov qab mus rau li qub, tab sis nws yog tsim nyog mus txuas ntxiv mus siv qhov ncauj anticoagulants, nws yog tsim nyog los "warfarin" mus ib ntus hloov cov tshuaj heparin series.

xaus

Kev siv cov antiplatelet tshuaj yuav tsis tau tsuas yog normalize cov ntshav rheological qauv, tab sis kuj los txhim kho lub dav mob ntawm tus neeg mob thiab tiv thaiv kom txhob loj hlob ntawm loj cov kab mob.

Ceev faj saib xyuas rau cov kev siv ntawm anticoagulants, cov kev xaiv ntawm ntau npaum thiab saib xyuas tus neeg mob tus mob yuav pab txo cov kev pheej hmoo ntawm cov teeb meem thiab kev vam meej. Cov tub txawg uas siv pab pawg neeg no ntawm cov tshuaj nyob rau hauv lawv cov kev xyaum, yog tsim nyog los txhim kho kev txawj ntse thiab ua raws li nruj me ntsis nrog thoob ntiaj teb noj qab haus huv pom zoo.