Iidakamizwa ze-NOAC - indawo yeCommmadin
Ukuba ubukela nayiphi na iTV, ngaba ukhangele ukuthengiswa kwezidakamizwa ezintsha ze- antiticoagulant (i-blood thinners) ebizwa ngePraxaxa, e-Eliquis, e-Xarelto nase-Savaysa. Iimfuno zorhwebo zibiza ezi zinto zilula ukuzithatha, zikhuselekile kwaye zichanekile (ukuba zingekho ngaphezulu) kuneCoumadin (warfarin).
Nangona ezi zibango zingenangqiqo, azixeleli ibali lonke.
Iingxaki NgeCoumadin
Kwizigulane ezifuna ukuthatha izidakamizwa ze-antiticoagulant (umzekelo, abantu abane- fibrillation ye-arrivals , i-thrombosis engummangaliso , okanye i- pulmonary embolus ), kwiminyaka emininzi kuphela okukhethwa ngu-Coumadin.
Ukusebenzisa i-Coumadin ngokukhuselekileyo nangempumelelo kungakuba ngumceli mngeni. Ngokuqhelekileyo kuyimfuneko ukuba ube nokuhlolwa kwegazi rhoqo ukuze ulinganise isimo se-coagulation ("ukucuthwa" kwegazi), kunye nokulungiswa rhoqo kwamayeza kufuneka ukuba kugcinwe isimo se-coagulation kwibanga elichanekileyo. Utshintsho kwimpilo, kunye nokutya ukutya okungafanelekanga, kunokukwenza igazi "lincinci" (elinokunyusa umngcipheko wegazi elikhulu), okanye "lingenanto elungeleyo" (enokunyusa umngcipheko wecala legazi). Kungcono, ukuthatha i-Coumadin kunzima.
Iziyobisi ezibonakaliswe kuzo zonke ezo ntengiso zivela kwiklasi elitsha leziyobisi, kwizigulane ezininzi, zinika enye iCommmadin. Oogqirha bahlala bebhekisela kula mayeza njengama-NOACs- "i-antiticoagulants yomlomo".
Indlela i-NOACs isebenza ngayo
Izidakamizwa zeAnticoagulant zisebenza ngokuthintela iziganeko ze-coagulation (nazo zibizwa ngokuba yizinto zokuvala i-clotting) egazini. Izinto zokuvala ziluhlu lweeprotheni ezisebenza ngokubambisana neeplatelet zegazi ukuvelisa i-blood clots.
U-Coumadin usebenza ngokuvimbela i-vitamin K, i-vitamin eyimfuneko yokuqulunqwa kwezinto ezininzi ezibalulekileyo zokuqhawula.
Enyanisweni, ukunika i-vitamin K yindlela efanelekileyo yokutshintsha ngokukhawuleza umphumo weCoumadin.
I-NOACs isebenza ngokuthintela ngokuthe ngqo izinto zokucima. Pradaxa (dabigatran) ngokukhawuleza inhibits thrombin, ebizwa ngokuba yi-clotting factor IIa.
Amanye amaNoacs atholakalayo-Xarelto (rivaroxaban), uEliquis (apixaban), kunye no-Savaysa (edoxaban) - umsebenzi ngokuthintela i-clotting factor, i-factor Xa.
Yintoni eyenza i-NOACs "ibe bhetele" kuneLoumadin?
I-NOACs inenzuzo enkulu kwi-Coumadin. Ngaloo nto, zivelisa i-antiticoagulant effect ezinomlinganiselo omgangatho, ngoko ke akukho mvavanyo yegazi okanye ukulungiswa kwemilinganiselo kuyadingeka. Kwaye akukho zithintelo zokutya ezinxulumene nokuthatha ii-NOACs. Ngoko ukuthatha ii-NOACs kudla ukuphazamisa ubomi bomntu kunokuba uthathe i-Coumadin.
Ngaphezu koko, uphando lwekliniki lucebisa ukuba ii-NOACs ziphumelele njengeCoumadin ekukhuseleni amacandelo egazi. Kwaye ingozi yokuxhamla kwegazi enkulu ne-NOACS ibonakala ingekho ngaphezu kweCoumadin (kwaye isenokuhlaselwa).
Ziziphi izinto ezithintekayo kwi-NOACs?
Mhlawumbi inkulu ingozi kukuba, ngokungafani neCourmadin, akukho nkunkuma ekhoyo okwangoku kukho ezintathu kwezi ziyobisi ukuze ziguqule ngokukhawuleza iziphumo zazo ze-anticoagulant.
Oku kuthetha ukuba xa kwenzeka isiqhelo esikhulu sokuphuma kwegazi, isiphumo esibi singasentla kunaseCourmadin.
Ngo-Oktobha, ngo-2015 i-FDA ivume le nkunkuma entsha Praxbind (idarucizumab) ukuguqula umphumo wePraxaxa. Ukufumaneka kwe-antidote ye Pradaxa kukuphuhliso olubalulekileyo.
Nangona kunjalo, ekubeni ezinye iilwimi ze-NOAC zikhona zivimbela i-Xa, kwaye akukho nto i-IIa efana ne Pradaxa, Praxbind ayiyikuguqula iziphumo zayo. I-Antidotes kwi-factor Xa i-inhibitors ziphuhliswa.
Pradaza kunye noEliquis badinga kabini ngosuku, ngokungafani no-Xarelto no-Savaysa (ne-Coumadin) okufuneka kuthathwe kanye ngosuku.
I-NOACs iyabiza kakhulu kuneCoumadin, kwaye iindleko zingavumelekanga kubantu abanomshuwalense awubathinteli.
I-NOACs ayivunyelwanga ukusetyenziswa kwezinye izinto, ngokomzekelo, kwizigulane ezineentsimbi zentliziyo okanye ezikhulelwe.
Ezi zi yobisi zixhaswa kakhulu yizintso, kwaye kufuneka zisetyenziswe ngokulumkisa, ukuba kukho konke, kwizigulane ezinezifo zengqondo.
Ekugqibeleni, ekubeni i-NOACs ngokwenene iyeza machiza, kunokwenzeka ukuba okongeziweyo, okwangoku kungabonakali kwimiphumo emibi engabonakali. (Lo mngcipheko umntu uthatha, ngokuqinisekileyo, nayiphi na isilwanyana esitsha.)
Xa kufuneka ii-NOAC zisetyenziswe?
Ngomlomo, lo ngumbuzo ukuba iingcali zonyango zilungele ngoku. Kodwa ngenxa yezinto ezinokuthi ziyaziwayo zeCoumadin, uninzi lweengcali zixhomekeke ngokufanelekileyo ekucebiseni izidakamizwa ezitsha zonyango njengeyokuqala kubantu abaninzi abafuna i-antiticoagulation yomlomo engapheliyo.
ILizwi
Iziyobisi ze-NOAC zinika ithuba elifanelekileyo kubantu abadinga unyango olungapheliyo, kwaye baninzi, lukhetho olukhangayo.
Abantu banokufumana oogqirha bacebisa elinye lamachiza amatsha ukuba baqaliswa kwi-antiticoagulation ngokokuqala ngqa, ukuba baye bafumana ubunzima bokugcina umthamo ozinzile weCoumadin, okanye ukuba (emva kokuphulaphula ingozi kunye neenzuzo kuzo zonke iinqunto) zona ngokwazo zibonisa ukukhetha okucacileyo kwiyeza elitsha. Ngakolunye uhlangothi, abantu abaye bathatha i-Coumadin ngempumelelo - kunye neemvavanyo zegazi ezizinzileyo kwisilinganisi esisisigxina - kwiinyanga ezimbalwa okanye ngaphezulu mhlawumbi kungcono ukunamathela kunye neCourmadin.
> Imithombo:
> I-Connolly SJ, uEzekowitz MD, uYusuf S, et al. I-Dabigatran Versus Warfarin Kwizigulane ezinezibilini ze-Atrial Fibrillation. N Engl J Med 2009; 361: 1139.
> Patel MR, Mahaffey KW, Garg J, et al. I-Rivaroxaban Versus Warfarin Kwi-Fibrillation ye-Asvalvular ye-Atrial Fibrillation. N Engl J Med 2011; 365: 883.
> Granger CB, uAlexander JH, uMcMurray JJ, et al. Apixaban Versus Warfarin Kwizigulane ezine-Fibrillation ye-Atrial. N Engl J Med 2011; 365: 981.
> Furie KL, Goldstein LB, Albers GW, et al. Ama-Oral Antithrombotic Agents ekukhuseleni iStroke kwi-Fibrillation ye-Asvalvular ye-Atrial Fibrillation: I-Advisory yeSayensi yezobuNgcululwazi kwi-American Heart Association / i-American Stroke Association. Stroke 2012.