Ukunyanga kwexesha elide kuyimfuneko, kodwa ingxaki
Kwiminyaka embalwa edlulileyo, ama- stents aye aqheleke kakhulu kunyango lwe- coronary artery disease . Ngethuba le nkqubela phambili ezininzi zenziwe ngeteknoloji enobuchule. Iingxaki eziye zabonwa kwiintsuku zokuqala, ezinjengokuchithwa kwe-stent ngaphakathi kwerteryary , kunye nezinga eliphezulu le- sten restenosis , liye lancitshiswa kakhulu nge-stents entsha (ngokukodwa, ngokusungulwa kwe-drug-eluting stents, ezivimbela ukukhula kweethambo ezinokubangela ukuba i-restenosis).
Kodwa ubuncinane ubunzima bodwa bunzima buhlala bunamaqabunga-ingozi ye- stent thrombosis . I-thrombosis ene-stent yenziwe ngokukhawuleza kwe-clot yegazi kwisiza se-stent, ebonakalayo ibangela ukuba kubekho ukugqithisa okukhawulezayo kunye nokugqibeleleyo kwe-artery coronary. I-thrombosis enamandla ayiyona ingxaki eqhelekileyo, kodwa xa kwenzekayo yintlekele, ngokuqhelekileyo iholele ekufeni okukhawulezayo okanye kwingozi ebangelwa yintliziyo .
Umngcipheko we-thrombosis ogqithisileyo uphezulu kwiiveki kunye neenyanga emva kokufakwa kwesigxina. Kodwa ngaphezu kweminyaka ihamba ngokucacileyo koogqirha ukuba le mngcipheko awusoze wanyamalala ngokupheleleyo, kwaye ukuba "ukupheka" kwe-stent thrombosis (oko kukuthi, i-thrombosis eyenzeka ngonyaka okanye emva koko emva kokufakwa kwesigxina) ihlala yinto ephantsi, kodwa inkulu kakhulu, kwenzeka.
Umngcipheko we-stent thrombosis unokuncitshiswa kakhulu xa abantu abafumene i-stents baqeshwe izidakamizwa ezimbini ezichasene neeplatelet ukuvimbela i-clotting yegazi: i- aspirin , kunye nenye ye-block2 ye-receptor blockers.
I-block2 ye-P2Y12 esetyenziselwa ukukhusela i-stent thrombosis yi-clopidogrel (i-Plavix-isetyenziswa ngokuqhelekileyo), i-prasugrel (Umphumo), kunye ne-ticagrelor (i-Brilinta).
Ukuthatha esinye sezidakamizwa ze-P2Y12 kunye ne-aspirin kuthiwa "yiphilisi yecala-anti-platelet" okanye i-DAPT.
Ukusetyenziswa kweDAPT Ukusetyenziswa
I-DAPT isebenza kakuhle ekunciphiseni umngcipheko we-stent thrombosis.
Ekuqaleni, i-DAPT yayisetyenziselwa inyanga emva kokubekwa kwe-stent, xa umngcipheko we-thrombosis uphezulu. Nangona kunjalo, oogqirha baqaphela ngokukhawuleza ukuba i-DAPT imele isetyenziswe ixesha elide, kwaye iminyaka emininzi umgangatho wonyango wawuyi-6 ye-DAPT.
Emva koko, kwiminyaka ye-2000 yokuqala, ingxaki ye-thrombosis yecala yafika emva koko yaqaphela, kwaye oogqirha abaninzi baqala ukuchaza i-DAPT kunyaka opheleleyo okanye ngaphezulu.
Njengoko ixesha lihamba phambili, iingxelo zaqala ukuqokelela i-stent thrombosis eyenzeka emva kwexesha elide (nangona iminyaka) emva kokufakwa kwesigxina. Uninzi lwezi ziganeko zenzeka emva nje kokuba i-DAPT ishiyiwe, nangona emva kokunyanga kwexesha elide. Oogqirha abaninzi banenkxalabo yokuba i-DAPT imele ifakwe ixesha elide-mhlawumbi iminyaka, okanye mhlawumbi ngonaphakade. Nangona kunjalo, idatha encinci ikhona ukuba unike oogqirha injongo ekujoliswe kuyo kwixesha elifanelekileyo le-DAPT elandela i-stent.
Studies
Isifundo se-DAPT senzelwe ukunika impendulo yokugqibela malunga nobude obude be-DAPT emva kokubekwa kweentente. Uhlolisiso lwababhalisa malunga nezigulane ezingama-10 ezingama-stent ezazisethatha i-DAPT iinyanga ezili-12. Babenomsebenzi wokuba bayeke i-DAPT kuloo ndawo, okanye baqhubeke kunye nezinye iinyanga ezili-18 (ubuncinane beenyanga ezingama-30).
Iziphumo, ezichazwe ngasekupheleni konyaka we-2014, zabonisa ukuba iinyanga ezingama-30 ze-DAPT zadibene nomngcipheko owancitshiswa kakhulu we-thrombosis esebenzayo, xa kuthelekiswa neenyanga ezili-12 zonyango. Uphando luye lwabonisa ukuba umngcipheko we-thrombosis wanda kakhulu malunga neenyanga ezi-3 okanye njalo xa i-DAPT imisiwe, nangemva kweminyaka yokusetyenziswa.
Ucwaningo lwe-DAPT lubonisa ukuba abantu baphathwa kwiinyanga ezi-30 ezipheleleyo baneziganeko ezingaphezulu kwegazi ezigqithisiweyo kwiinyanga ezili-12.
Ngoko: ukufundiswa kwe-DAPT kubonise ukuba iinyanga ezingama-30 ze-DAPT zingcono kuneenyanga ezili-12 zonyango ekukhuseleni i-stent thrombosis.
Kwakhona kuqinisekisile ukuba kukho i-spike ephawulekayo emngciphekweni we-thrombosis xa ushiya i-DAPT, nangemva kokusetyenziswa kwexesha elide. Ekugqibeleni, kuboniswe ukuba kukho urhwebo kunye ne-DAPT yexesha elide-thrombosis egciniweyo, kodwa iziganeko zokuphelisa igazi. Ezinye izilingo ezinokuthi zijonge kwixesha elide le-DAPT unyango emva kokugquma kubonise imiphumo efanayo.
Mngeni
Ukuthatha i-DAPT ngokwayo kubangela umngcipheko wee-episodes zokuphuma kwegazi, kwaye isifundo se-DAPT siqinisekisile ukuba ixesha elide umntu ethatha i-DAPT, iphakamileyo yengozi yegazi elikhulu. Kuba naliphi na umntu othabatha i-DAPT, isiqhelo somngcipheko olinganisekileyo (njengengozi yemoto engabikho mngcipheko ochaphazelekayo) unokuba yingozi kakhulu ngenxa yokuphuma kwegazi.
Kwakhona, ngenxa yokuba ukuphuma kwamanzi kunzima ukulawula kwi-DAPT, abaninzi abagqirha banqabile kakhulu ukusebenza kumntu othabatha iDAPT.
Eneneni, lo mbandela malunga nokuhlinzwa udala ingxaki enkulu kwizigulane ezininzi ezineentente. Ngakolunye uhlangothi i-cardiologist yabo ingabaxelela ukuba bangaze bayeke, bayeke ukuyeka i-DAPT (ngenxa yengozi enkulu ye-thrombosis stent); Ngakolunye uhlangothi, ugqirha unokubaxelela ukuba banesidingo esikhulu, kwaye i-DAPT kufuneka imiswe ukuba kuvunywe ukuhlinzwa.
Isayensi yezokwelapha ayilanga isisombululo kule ngxaki eqhelekileyo. Iingcali zenzululwazi yinkalo enomdla ukusebenzela; ezinye zeengcali ze-cardiologists yinkathazo engelusizi eyenziwa ngumguli ukuba aphephe ukuzilimaza ngokwabo, okanye ukungaphumeleli isidingo sokuhlinzwa; izigulane zinokuba yingxaki yokuguqula ubomi, kunye nombandela onokukhathazeka ngokukodwa xa bengakhange bafumane ngokwaneleyo impembelelo ye-DAPT ngaphambi kokuba bavume ukufumana i-stent.
Kwimeko ezininzi ukuba utyando alukwazi ukuphetshwa, yonke imizamo yenziwa ukuqhubeka i-DAPT unyaka emva kokubekwa kwe-stent-okanye ubuncinci, kwiinyanga ezintandathu-ngaphambi kokuba uyimise.
Iziphakamiso zangoku
Uninzi lwezifo ze-cardiologists zixininisa izigulane zazo ezigulisayo zithatha i-DAPT ubuncinane ubuncinane kweenyanga ezili-12, ngaphandle kokuba isigulane sinomngcipheko okhulayo ngokukhupha. Emva kweenyanga ezili-12, ukuhlolwa kwakhona kufuneka kwenzeke, kwaye ukuba kunokwenzeka, i-DAPT ifanele iqhutywe kwezinye iinyanga ezili-18.
ILizwi
I-DAPT iyimfuneko emva kokuba i-stent, kodwa ingabonisa iingxaki zayo. Uluntu lwezonyango luyahlengahlengisa umlinganiselo wengozi ye-DAPT yexesha elide, kwaye mhlawumbi iya kuba yithuba ngaphambi kokufikelela kwesinye isivumelwano.
Okwangoku, xa isifo se-cardiologist sikhuthaza unyango olusisigxina kumntu one-coronary artery disease, kufuneka azive enyanzelekile ukuba ahlaziye kunye nesigulane, ngokucacileyo, zonke iimpembelelo zento yokuba i-DAPT yexesha elide liyinxalenye yendalo unyango. Zonke ezinye iindlela zokwenza unyango olusisigxina nazo kufuneka zixubushe ngokugcwele, ukwenzela ukuba isinqumo esinokwenene sinokwenziwa.
> Imithombo:
> I-Columbo A ne-Chieffo A. I-Anti-Teal Antiplatelet Isifo Emva kweDrug-Eluting Stents-Ixesha Elide Liyiphathe? N Engl J Med 2014; INGXELO: 10.1056 / NEJMe1413297.
> Mauri L, Kereiakes DJ, Yeh RW, et al. Ezilishumi elinambini okanye kwiinyanga ezingama-30 zonyango lwe-Anti-platelet emva kweDrug-Eluting Stents. N Engl J Med 2014; INGXELO: 10.1056NEJMoa1409312.
> Sammy Elmariah, uLaura Mauri, uGheorghe Doros, et al. Isikhathi esongezelelweyo IsiCwangciso soPhulo lwe-Antiplatelet kunye nokufa: uVavanyo oluHlolo kunye ne-Meta-Analysis. Lancet 2014; INGXELO: 10.1016 / S0140-6736 (14) 62052-3.
> Levine GN, Bates ER, Blankenship JC, et al. Umhlahlandlela we-ACCF / AHA / SCAI ka-2011: INgxelo ye-American College of Cardiology Foundation / i-American Heart Association iqela leMisebenzi yeZikhokelo kunye noMbutho we-Cardiovascular Angiography kunye neNguqulelo. Ukuhamba ngo-2011; 124: e574.