Imithi ye-NOAC - abafaka esikhundleni seCoumadin
Uma ubheka noma yikuphi i-TV, kunzima ukuthi ubona ukuhweba kwezidakamizwa ezintsha ze- anticoagulant (igazi elincane) okuthiwa i-Pradaxa, Eliquis, Xarelto, no-Savaysa. Izimakethe zithi lezi zidakamizwa zilula ukuzithatha, ziphephile, futhi ziphumelela (uma zingasebenzi kangcono) kuneCoumadin (warfarin).
Nakuba lezi zimangalo zingenangqondo, azitsheli lonke indaba.
Izinkinga NgeCoumadin
Kulezi ziguli ezidinga ukuthatha izidakamizwa ze-anticoagulant (isibonelo, abantu abane -fibrillation e-atrial , thrombosis ejulile ye-venous , noma i- pulmonary embolus ), iminyaka eminingi ukhetho olulodwa kuphela oluyi-Coumadin.
Ukusebenzisa i-Coumadin ngokuphepha nangokuphumelelayo kungaba yinselele yangempela. Ngokuvamile kuyadingeka ukuba uhlolwe njalo ngegazi ukuze ulinganise isimo se-coagulation ("ukuncane" kwegazi), futhi ukulungiswa njalo kwesilinganiso kudingekile ukugcina isimo se-coagulation ebangeni elifanele. Izinguquko empilweni, ngisho nokudla ukudla okungalungile, zingenza igazi "libe mncane kakhulu" (okungangandisa ingozi yokugaya kakhulu), noma "hhayi okwanele" (okungangandisa ingozi yezindwangu zegazi). Ngcono kakhulu, ukuthatha u-Coumadin kuyinkinga enkulu.
Izidakamizwa ezivezwe kuzo zonke lezo zentengiso zivela ekilasini elisha lezidakamizwa, ezigulini eziningi, zinikeza okuhlukile ku-Coumadin. Odokotela bavame ukubhekisela kulezi zidakamizwa njenge-NOACs - "ama-anticoagulants omlomo omusha."
Indlela i-NOACs isebenza ngayo
Izidakamizwa ze-Anticoagulant zisebenza ngokuvimbela izici ze-coagulation (ezibizwa nangokuthi izici zokuvala) egazini. Izici zokuvala zihlanganisa uchungechunge lwamaprotheni asebenza ngokubambisana namaplatelethi egazi ukukhiqiza ama-blood clots.
I-Coumadin isebenza ngokuvimbela i-vitamin K, i-vithamini edingekayo ukuze kuhlanganiswe izici eziningana ezibalulekile zokuvala.
Eqinisweni, ukunikeza i-vitamin K kuyindlela ephumelelayo yokuguqula ngokushesha umphumela weCoumadin.
I-NOACs isebenza ngokuvimbela ngqo izici zokuvala izici ezithile. I-Pradaxa (dabigatran) ivimbela ngqo i-thrombin, ebizwa nangokuthi i-clotting factor IIa.
Amanye ama-NOACs atholakalayo - i-Xarelto (rivaroxaban), u-Eliquis (apixaban), no-Savaysa (edoxaban) - umsebenzi ngokuvimbela isici esithile sokuhlukanisa, i-factor Xa.
Yini eyenza i-NOAC "ibe ngcono" kuneCoumadin?
I-NOACs inenzuzo enkulu phezu kweCoumadin. Ngokufanayo, zikhiqiza umphumela we-anticoagulant ozinzile ngezinga elijwayelekile, ngakho-ke akukho ukuhlolwa kwegazi noma ukulungiswa kwesilinganiso okudingekayo. Futhi ayikho imikhawulo yokudla ehlobene nokuthatha ama-NOACs. Ngakho ukuthatha i-NOACs kuvame ukuphazamisa kakhulu empilweni yomuntu kunokuba uthathe u-Coumadin.
Ngaphezu kwalokho, izifundo zokwelashwa ziphakamisa zisikisela ukuthi ama-NOACs asebenza kahle njengeCoumadin ekuvimbeleni ama-clots egazi. Futhi ingozi yokucindezeleka okukhulu kwegazi ne-NOACS kubonakala ingekho ngaphezu kweCoumadin (futhi ingase ibe ngaphansi).
Yiziphi Izinkomba Zama-NOAC?
Mhlawumbe inhloko engalungile yukuthi, ngokungafani neCoumadin, akukho-antidote okwamanje etholakala kulezi zidakamizwa ukushintsha ngokushesha imiphumela yabo ye-anticoagulant.
Lokhu kusho ukuthi uma kwenzeka isiqephu esikhulu sokugaya, kungenzeka ukuthi umphumela omubi ungaphezulu kuneCoumadin.
Ngo-Okthoba, i-FDA ivume isidakamizwa esisha uPraxbind (idarucizumab) ukuguqula imiphumela yePradaxa. Ukutholakala kwe-antidote kuPradaxa kuyisimo esibalulekile sokuthuthukiswa.
Kodwa-ke, njengoba ezinye izidakamizwa ze-NOAC ezitholakalayo zivimbela i-factor ye-Xa, futhi akuyona into ebaluleke kakhulu i-IIa efana ne-Pradaxa, i-Praxbind ayibuyiseli imiphumela yabo. Ukuphikisana ne-factor Xa inhibitors kuthuthukiswa.
IPradaza no-Eliquis badinga ukuphindwa kabili ngosuku, ngokungafani ne-Xarelto no-Savaysa (no-Coumadin) okumelwe kuthathwe kanye ngosuku.
I-NOACs iyabiza kakhulu kuneCoumadin, futhi izindleko zingavunyelwa abantu abangabathwali umshwalense wabo.
I-NOACs ayivunyelwe ukusetshenziswa kwezinye izinto, isibonelo, ezigulini ezinezinhliziyo zamagciwane noma ezikhulelwe.
Lezi zidakamizwa zithandwa kakhulu yizinso, futhi kudingeka zisetshenziswe ngokuqapha okukhulu, uma kunjalo, ezigulini ezinesifo sezinso.
Okokugcina, njengoba i-NOACs impela imithi emisha, kungenzeka ukuthi okungeziwe, okwamanje kungabonakali imiphumela emibi. (Lena ingozi eyodwa ithatha, noma kunjalo, nganoma isiphi isidakamizwa esisha.)
Ama-NOAC Kufanele Asetshenziswe Nini?
Ngokweqiniso, lo ngumbuzo ukuthi ochwepheshe bezokwelapha bavele bahlela kanjani. Kodwa ngenxa yezingqinamba ezidumile zaseCoumadin, ochwepheshe abaningi bancike ngokuqinile ekunconyeni izidakamizwa ezintsha ze-anticoagulant njengokukhetha kuqala kubantu abaningi abadinga i-antiticoagulation yomlomo engapheli.
Izwi elivela
Izidakamizwa ze-NOAC zinikeza ithuba elihlukile kubantu abadinga ukwelashwa okungahambi kahle kwe-anticoagulation, futhi kwabaningi, kuyindlela ekhangayo.
Abantu kungenzeka bathole odokotela babo batusa omunye wezidakamizwa ezintsha uma beqala i-anticoagulation okokuqala, uma bekunzima ukugcina umthamo oqinile weCoumadin, noma uma (ngemuva kokulalela izingozi nezinzuzo ezingase zibe khona kuzo zonke izinqumo) zona ngokwazo ziveza ukukhetha okucacile kwezidakamizwa ezintsha. Ngakolunye uhlangothi, abantu abaye bathatha u-Coumadin ngempumelelo - ngokuhlolwa okunamandla kwegazi esiteshini esinqinile - izinyanga ezimbalwa noma ngaphezulu cishe kungcono ukunamathela ne-Coumadin.
> Imithombo:
> Connolly SJ, Ezekowitz MD, Yusuf S, et al. I-Dabigatran Versus Warfarin Ezigulini Eziphefumula Nge-Atrial Fibrillation. N Engl J Med 2009; 361: 1139.
> Patel MR, Mahaffey KW, Garg J, et al. I-Rivaroxaban Versus Warfarin E-Fibrillation Ye-Atrial Nonvalvular. N Engl J Med 2011; 365: 883.
> Granger CB, Alexander JH, McMurray JJ, et al. Apixaban Versus Warfarin Ezigulini Eziphefumula Nge-Atrial Fibrillation. N Engl J Med 2011; 365: 981.
> Furie KL, Goldstein LB, Albers GW, et al. Ama-Oral Antithrombotic Agents for the Prevention of Stroke In Fibrillation Ye-Nonvalvular Atrial Fibrillation: Iseluleko Sezesayensi Sobungcweti Bezempilo Kusukela ku-American Heart Association / American Stroke Association. Isibhamu 2012.