I-thrombosis , noma i- blood clotting engavamile, ivame ukuyisimo esiyingozi kakhulu eveza izinhlobo ezimbili zezinkinga zezokwelapha.
Okokuqala, ukuxubha ngaphakathi kwe-artery kungavimbela ukugeleza kwegazi, kudala umonakalo ezithombeni ezihlinzekwa umthamo ovinjiwe. Ukuhlukunyezwa kwe-myocardial (ukuhlaselwa kwenhliziyo) kuvame ukubandakanya i-thrombosis ngaphakathi kwe-artery coronary , futhi ukushaywa yi-thrombosis kubangelwa yi-thrombosis ngaphakathi kwesinye sezifo ezithinta ubuchopho.
Okwesibili, i-thrombosis eyenzeka ngaphakathi kwe-vein noma ngaphakathi enhliziyweni ingayifaka . Lokhu kungukuthi, i-clot yegazi ingasuka futhi ihambe ngokusebenzisa isimiso sezinsiza, yenza umonakalo nomaphi lapho igcina khona. I- pulmonary embolus ibangelwa i-clot yegazi efaka emaphashini (ngokuvamile, kusuka emthanjeni emlenzeni). Ukushaywa kwe-embolic kubangelwa i-clot yegazi ehambela ebuchosheni, ngokuvamile ephuma e-thrombus ngaphakathi enhliziyweni, ngokuvamile ehlangene ne -fibrillation ye-atrial .
Izidakamizwa Ezivimbela noma Eziphatha Izambatho Zegazi
Abantu abasengozini enkulu yokuthuthukisa i-thrombosis eyingozi ngokuvamile badinga ukwelashwa ukuvimbela lesi simo ukuba singenzeki noma ukuzama ukuhlakaza ama-blood clots asevele awakhiwe. Kunezigaba ezintathu ezijwayelekile zezidakamizwa ezivame ukusetshenziselwa ukuvimbela noma ukuphatha i-thrombosis - izidakamizwa ze-anticoagulant, izidakamizwa ze-fibrinolytic, kanye nezidakamizwa ezilwa ne-plateletlet.
Ngenkathi ngayinye yalezi zidakamizwa inephrofayili yayo yemiphumela emibi, umphumela owodwa ohlangothini ojwayelekile kubo bonke ukuphuma kwegazi ngokweqile.
Ngakho zonke lezi zidakamizwa kumele zisetshenziswe ngokuqapha okufanelekile.
Izidakamizwa ze-Anticoagulant
Izidakamizwa ze-anticoagulant zivimbela eyodwa noma ngaphezulu izici zokuvala . Izici zokuvala ziyingxenye yamaprotheni egazi anesibopho sokuvala igazi.
Lezi zidakamizwa zifaka:
I-Heparin. I-Heparin iyizidakamizwa ezinomzimba ezinomzimba osheshayo (ngemizuzwana) nomphumela wokuvimbela izici zokuvala.
Odokotela bangakwazi ukulungisa umthamo wayo njalo, njengoba kudingeka, ngokuqapha ukuhlolwa kwegazi kwe-thromboplastin (PTT) . I-PTT ibonisa ukuthi izici ze-clotting ziye zavinjelwa kangakanani. (Okungukuthi, kubonisa ukuthi "ukuncane" kwegazi.) I-Heparin isetshenziswa kuphela iziguli ezibhedlela.
Heparin Weight Weight Weight: i-enoxaparin (Lovenox), i-dalteparin (i-Fragmin). Lezi zidakamizwa zivela ezihlanjululweyo ze-heparin. Inzuzo yabo enkulu phezu kwe-heparin yukuthi banganikezwa njengezijoki zesikhumba (cishe noma ubani angafunda ukwenza emaminithini ambalwa) esikhundleni se-intravenously, futhi akudingeki ukuba aqashwe ngokucophelela ngokuhlolwa kwegazi. Ngakho-ke, ngokungafani ne-heparin, zingenziwa ngokuphepha okuhlobene nesiguli.
Izindlela zokudambisa ezitholakalayo ezisha noma ezithandwayo-izidakamizwa ze-Anticoagulant eziphathwayo. Kuye kwakhiwa izidakamizwa eziningana "ze-heparin" ze-anticoagulant, kuhlanganise i-argatroban, i-bivalirudin (i-Angiomax), i-fondaparinux (i-Arixtra) ne-lepirudin (Refludan). Isikhathi nendawo efanele yokusebenzisa zonke lezi zidakamizwa zenziwa kancane kancane.
I-Warfarin (i-Coumadin). Kuze kube yamuva, i- warfarin yilapho kuphela izidakamizwa ezenziwe ngomlomo ezitholakalayo ngomlomo.
Inkinga enkulu nge-warfarin bekulokhu ukulungisa umthamo wayo.
Uma kuqala kuthathwa, umthamo we-warfarin kumele uqiniseke ngesikhathi semasonto ngokuhlolwa kwegazi njalo (ukuhlolwa kwegazi le-INR). Ngisho nangemva kokuqiniswa i-INR kusadingeka ukuba ihlolwe ngezikhathi ezithile, futhi umthamo we-warfarin ngokuvamile udinga ukulungiswa kabusha. Ngakho-ke, ukufika nokulondoloza umthamo "wokunene" we-warfarin bekulokhu kunzima futhi kungathandeki.
"Izidakamizwa ezishaya ngomlomo" ezintsha ze-NOAC - I-NOAC izidakamizwa. Ngenxa yokuthi umthamo omkhulu we-warfarin ungaba nzima ukuphatha, izinkampani ezidakamizwa ziye zasebenzela iminyaka ezayo "izimpendulo ze-warfarin" - okungukuthi, izidakamizwa ze-anticoagulant ezingathathwa ngomlomo.
Amane kulezi zidakamizwa ezintsha ze-anticoagulant (izidakamizwa ze-NOAC) manje sezivunyiwe.
Lawa yi-dabigatran (Pradaxa), i-rivaroxaban (i-Xarelto), i-apixaban (i-Eliquis), ne-edoxaban (i-Savaysa). Inzuzo enkulu yalezo zonke izidakamizwa ukuthi zinganikezwa ezinyangeni zansuku zonke ezihleliwe, futhi azidingi ukuhlolwa kwegazi noma ukulungiswa kwesilinganiso. Kodwa-ke, njengoba kunjalo nazo zonke izidakamizwa, kukhona ukwehla kwezidakamizwa ze-NOAC .
Izidakamizwa ze-Fibrinolytic
Streptokinase, urokinase, alteplase, reteplase, tenecteplase. Lezi zidakamizwa ezinamandla zinikezwa ngokucophelela nangenhlanhla ukuqeda ama-blood clots asezinqubo zokwakha. Ngokuyinhloko, ukusetshenziswa kwabo kunqunyelwe iziguli ezisekuqaleni kwamahora ambalwa wokuhlasela kwenhliziyo ehlabayo noma isifo sohlangothi, futhi banikezwa ukuzama ukuvula umthamo ovimbekile nokuvimbela ukulimala okuhlala unomphela.
Izidakamizwa ze-fibrinolytic (okuvame ukubizwa ngokuthi "i-clot busters"), kungaba yinkinga ukusebenzisa. futhi zithwala ingozi enkulu yokuphefumula. Nokho, ezimweni ezifanele, ukusetshenziswa kwezidakamizwa kungavimbela ukufa noma ukukhubazeka ekuhlaselweni kwenhliziyo noma ngesifo sohlangothi. Kulezi zidakamizwa ze-fibrinolytic, i-streptokinase isetshenziselwa kakhulu emhlabeni jikelele, ngoba ishibhile. E-United States, i-tenecteplase okwamanje iyisidakamizwa sokuzikhethela ngoba kubonakala sengathi ibangela imiphumela embi yokukhipha igazi, futhi kulula ukulawula kunezinye izidakamizwa kuleli qembu.
I-anti-platelet izidakamizwa
Amaqembu amathathu ezidakamizwa asetshenziselwa ukunciphisa "ukunamathela" kwamaplatelets , izakhi zegazi ezincane ezakha i-nucleus ye-clot yegazi. Ngokuvimbela ikhono lamaplatelets ukuhlanganiswa ndawonye, izidakamizwa ezilwa nama-platelet zivimbela ukuvala igazi. Lezi zidakamizwa ziphumelela kakhulu ekuvimbeleni ama-clots angavamile egazi kusukela ekusebenzeni emithanjeni futhi asebenze kangcono ekuvikeleni i-thrombosis emithanjeni.
I-aspirin ne-dipyridamole (i-Aggrenox). Lezi zidakamizwa zinomthelela omncane ku-platelet "stickiness" kodwa zenza imiphumela embi kakhulu ehlobene nokuphuma kwegazi kunezinye izidakamizwa eziphikisayo. Zivame ukusetshenziselwa umzamo wokunciphisa ubungozi bokuhlaselwa kwenhliziyo noma ukushaya isifo kubantu abanengozi ephakanyisiwe.
I-Ticlopidine (i-Ticlid), i-clopidogrel (i-Plavix) ne-prasugrel (Umphumela). Lezi zidakamizwa zinamandla kakhulu (futhi ngenxa yalokho i-riskier) kune-aspirin ne-dipyridamole. Zivame ukusetshenziswa lapho ingozi yokugubha i-arterial clotting iphezulu kakhulu. Isicelo sabo esivame kakhulu kunabantu abaye bathola ama-stent artery stents . Ukusetshenziswa kwabo ngokuphathelene nama-stents - ikakhulukazi, izinqumo mayelana nokuthi zisetshenziswe nini nokuthi zisetshenziswa kangakanani- ziye zaphikisana .
IIb / IIIa Inhibitors: abciximab (ReoPro), i-eptifibatide (i-Integrilin), i-tirofiban (i-Aggrastat). Izidakamizwa ze IIb / IIIa inhibitor yiqembu elinamandla kakhulu lama-platelet inhibitors. Zivimbela i-receptor ebusweni bamapulethi (okubizwa okuthiwa i-IIb / IIIa receptor) okubalulekile ekutheni i-plateslet ishicilelwe. Ukusetshenziswa kwabo okuyinhloko ukuvimbela ukuvala ama-acute ngemuva kwezinqubo zokungenelela (njengokungena kwe- angioplasty nokubekwa kwe- stent ), kanye neziguli ezine- aron coronary artery syndrome . Lezi zidakamizwa zibiza kakhulu futhi (ngokujwayelekile) kufanele zinikezwe ngaphakathi.
Izwi elivela
Izidakamizwa eziningana zisetshenziselwa ukuvimbela noma ukuphatha ama-blood clots. Zinezinqubo ezahlukene zezenzo, izingozi ezahlukene, futhi ziyasetshenziswa ngaphansi kwezimo ezahlukene zemitholampilo. Ukusebenzisa noma iyiphi yalezi zidakamizwa njalo kubeka ingozi yokugaya okungavamile, futhi kufanele kusetshenziswe kuphela uma izinzuzo zabo zingaphezu kwezingozi. Uma ulawula i-thrombosis, kubaluleke kakhulu ukuthi udokotela akhethe isidakamizwa esifanele, ngaphansi kwesimo esifanele.
> Imithombo:
> Franchini M, Mannucci PM. Ama-Anticoagulants Amasha Ezokwelapha Ngaphakathi: Isibuyekezo. I-Eur J Intern Med 2010; 21: 466.
> Kearon C, Akl E, Omelas J, et al. I-Antithrombotic Therapy ye-VTE Izifo. Isiqondiso se-CHEST kanye ne-Umbiko wePanethi yezobuchwepheshe. Isifuba 2016; 149: 315.
> Weitz JI, Hirsh J, Samama MM, American College of Chest Physicians. Izidakamizwa ezintsha ze-Antithrombotic: I-American College of Chest Physicians Iziqondiso Zokwenziwa Kokutholwa Kwemitholampilo (I-8th Edition). I-Chest 2008; 133: 234S.