French anticoagulant Fraxiparin: ndi chiyani ndipo chifukwa chiyani imalembedwa?

Njira yothetsera jakisoni ndi yowonekera kapena pang'ono opalescent, wopanda utoto kapena wachikasu.

Othandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid kuti pH 5-7,5 mpaka pH 5.0-7.5, madzi d / mpaka 0,6 ml.

0,6 ml - ma syringes a single-2 (2) - matuza (5) - mapaketi a makatoni.

r d / jakisoni. 9500 IU anti-Xa / 1 ml: 0,8 ml syringes 10 ma PC.
Reg. Nambala: 4110/99/05/06 ya 04/28 / 2006 - Coll

Njira yothetsera jakisoni ndi yowonekera kapena pang'ono opalescent, wopanda utoto kapena wachikasu.

Othandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid kuti pH 5-7,5 mpaka pH 5.0-7.5, madzi d / mpaka 0,8 ml.

0,8 ml - syringes ya single-2 (2) - matuza (5) - mapaketi a makatoni.

Zotsatira za pharmacological

Calcium nadroparin ndi heparin (NMH) yotsika kwambiri yolemetsa. Ndi glycosaminoglycan yokhala ndi kulemera pafupifupi mamiliyoni 4300 daltons.

Imawonetsa kuthekera kwakukulu komwe kumangiriza mapuloteni a plasma ndi antithrombin III (ATIII). Kumangiriza kumeneku kumabweretsa kuyendetsa patsogolo kwambiri kwa factor Xa, komwe kumachitika chifukwa cha kuthekera kwakukulu kwa nadroparin. Calcium nadroparin imadziwika ndi ntchito yapamwamba ya anti-Xa chinthu poyerekeza ndi anti-IIa factor kapena antithrombotic zochita.

Njira zina zopereka antithrombotic ntchito ya nadroparin zimaphatikizira kukondoweza kwa minofu chinthu chamtundu wa inhibitor (TFPI), kutsegula kwa fibrinolysis ndikumasulidwa mwachindunji kwa minofu ya plasminogen activator kuchokera ku maselo a endothelial, ndikusintha kwamitsempha yamagazi ndi kuchepa kwa kuchuluka kwa magazi ndi kuphatikizira kwa kuphatikizika kwa kuphatikizira kwa magazi.

Nadroparin ndi heparin yotsika kwambiri yolemetsa yomwe ma antithrombotic ndi anticoagulant a standard heparin amalekanitsidwa, amadziwika ndi zochitika zapamwamba motsutsana ndi factor Xa, poyerekeza ndi zochita motsutsana ndi factor IIa. Imakhala ndi zochita za antithrombotic nthawi yomweyo komanso nthawi yayitali. Chiwerengero pakati pa mitundu iyi ya nadroparin calcium imakhala mu 2.5-4.

Poyerekeza ndi heparin yopanda kukonzekera, nadroparin imakhala yocheperako pakugwira ntchito ya maplatelet ndi kuphatikiza ndipo imakhala yovuta kutchulira he hetasis ya pulayimale.

Mlingo wa prophylactic, nadroparin sayambitsa kuchepa kutchulidwa kwa gawo la thrombin nthawi (APTT).

Ndi chithandizo cha mankhwala munthawi ya zochitika zapamwamba, kuwonjezeka kwa APTT pamtengo 1.4 nthawi zambiri kuposa momwe mungathere. Kutalika kotereku kumatsalira otsalira a antithrombotic mphamvu ya calcium nadroparin.

Pharmacokinetics

Facacokinetic katundu amatsimikiza pamaziko a kusintha kwa ntchito ya anti-Xa chinthu cha plasma.

Pambuyo pa utsogoleri wa sc, mayamwidwe ali pafupifupi 100%. C max m'madzi a m'magazi amafikira pakati pa maola atatu ndi asanu.

Mukamagwiritsa ntchito calcium nadroparin mu regimen 1 jekeseni / tsiku, max amakwaniritsidwa pakati pa maola 4 ndi 6 pambuyo pa kukhazikitsa.

Zimapangidwa makamaka mu chiwindi mwa kuwonongedwa ndi depolymerization.

Pambuyo pa sc 1 ya T-2 ya anti-Xa factor ya ntchito ndi maola 3-4. Mukamagwiritsa ntchito heparin yama cell ochepa, anti-IIa factor shughuli imazimiririka ku plasma mwachangu kuposa ntchito ya anti-Xa factor. Ntchito ya Anti-Xa imawonetsedwa mkati mwa maola 18 pambuyo pakupereka mankhwala.

Imapukutidwa makamaka ndi impso m'njira yosasinthika kapena ma metabolites omwe amasiyana pang'ono ndi chinthu chosasinthika.

Pharmacokinetics mu milandu yapadera yamankhwala

Odwala okalamba, chifukwa cha kuchepa kwa thupi kwa impso, kuchepa kumachepa. Mukamagwiritsa ntchito mankhwala a prophylaxis m'gulu lino la odwala, palibe chifukwa chosintha mankhwalawa chifukwa cha kufooka kwa impso.

Asanayambe chithandizo cha LMWH (hematin yochepa), ntchito yaimpso ya okalamba omwe ali ndi zaka zopitilira 75 iyenera kuyesedwa mwadongosolo pogwiritsa ntchito njira ya Cockcroft.

Odwala kwambiri aimpso kulephera ndi s / c makonzedwe a nadroparin, T 1/2 amapitilizidwa mpaka maola 6, chifukwa chake nadroparin amatsutsana pochiza odwala. Mukamagwiritsa ntchito nadroparin mu prophylactic Mlingo m'gulu lino la odwala, mlingo uyenera kuchepetsedwa ndi 25%.

Odwala omwe amalephera kupezeka ndi aimpso (CC oposa 30 ml / mphindi), nthawi zina amauzidwa kuti azilamulira machitidwe a anti-Xa chinthu m'magazi kuti asamayankhe mwayi womwe ungachitike chifukwa cha mankhwala. Kudzikundikira kwa nadroparin kumatha kuchitika m'gulu ili la odwala, motero, mwa odwala oterewa, mlingo wa nadroparin uyenera kuchepetsedwa ndi 25% pochiza matenda a thromboembolism, angina osakhazikika komanso infarction ya myocardial yopanda ma pathological Q. Mu gawo ili la odwala omwe amalandila nadroparin popewa zovuta za thromboembolic, zomwe zili nadroparin sichidutsa kuti odwala ndi abwinobwino aimpso ntchito akutenga achire Mlingo wa nadroparin. Chifukwa chake, kuchepetsa mlingo wa nadroparin wotengedwa ngati njira yodzitchinjiriza mwa odwala sikofunikira.

Pa hemodialysis, kuyambitsa kwamphamvu maselo kulemera ochepa maselo heparin mu ochepa mzere wotsekemera wa dialysis dongosolo (pofuna kuteteza magazi kuundana) sizimayambitsa kusintha kwa mapiritsi a pharmacokinetic, kupatula pokhapokha ngati pali mankhwala ochulukirapo, pomwe mankhwalawa amalowera munthawi yama cell angayambitse kuchuluka kwa ntchito ya anti-Xa, zogwirizana ndi kutha kwa gawo laimpso.

Zizindikiro zogwiritsidwa ntchito

• kupewa thrombosis pa nthawi ya opaleshoni ndi mafupa,
• kupewa kupezeka kwa magazi mu njira yotulutsa magazi kunja kwa hemodialysis kapena hemofiltration,
• kupewa zovuta za thromboembolic kwa odwala omwe ali ndi chiopsezo chachikulu cha thrombosis (kupuma kwambiri komanso / kapena kulephera kwa mtima pazinthu za ICU),
• chithandizo cha thromboembolism,
• mankhwalawa osakhazikika angina ndi myocardial infarction popanda pathological Q funde pa ECG.

Mlingo

Mankhwalawa amaperekedwa s / c (pokhapokha ngati angagwiritse ntchito hemodialysis). Fomu ya Mlingoyo idapangidwira achikulire. Mankhwalawa satumizidwa m'mafuta. 1 ml ya Fraxiparin ndi wofanana ndi 9500 ME wa anti-Xa factor ya calcium nadroparin.

Kuteteza kwa Supomboembolism mu Opaleshoni

Malangizowa akukhudzana ndi maopareshoni omwe amachitidwa pansi pa opaleshoni wamba.

Pafupipafupi kugwiritsa ntchito mankhwalawa 1 jakisoni / tsiku.

Mlingowo umatsimikiziridwa ndi kuchuluka kwa chiwopsezo cha thromboembolism mu vuto linalake lazachipatala ndipo zimatengera kulemera kwa thupi ndi mtundu wa ntchito.

Ndi chiwopsezo chokwanira cha thrombogenic, komanso mwa odwala osakhala ndi chiwopsezo chowonjezereka cha thromboembolism, kupewa matenda a thromboembolic kumatheka mwa kupereka mankhwalawa pa mlingo wa 2850 ME / tsiku (0.3 ml). Jakisoni woyamba amaperekedwa maola awiri asana opaleshoni, ndiye kuti nadroparin imaperekedwa 1 nthawi / tsiku. Chithandizo chimapitilizidwa kwa masiku osachepera 7 komanso munthawi ya chiwopsezo cha thrombosis kufikira wodwala atamuika kumalo ena.

Ndi chiwopsezo chowonjezeka cha thrombogenic (opaleshoni m'chiuno ndi bondo), mlingo wa Fraxiparin umatengera kulemera kwa thupi la wodwalayo. Mankhwalawa amaperekedwa pa mlingo wa 38 ME / kg musanachitike opaleshoni, i.e. Maola 12 asanafike pamchitidwewo, ndiye pambuyo pa opareshoni, i.e. kuyambira maola 12 pambuyo pa kutha kwa njirayi, ndiye kuti nthawi 1 / tsiku mpaka masiku atatu atatha opereshoni. Kuphatikiza apo, kuyambira masiku 4 atachitidwa opareshoni, 1 nthawi / tsiku pa mlingo wa 57 ME / kg panthawi ya chiopsezo cha thrombosis musanatumize wodwala kumalo omwe akukonzekera. Kutalika kochepa ndi masiku 10.

Mlingo wa Fraxiparin kutengera kulemera kwa thupi zimaperekedwa pagome.

Popereka mankhwala kwa odwala omwe sanachitidwe opaleshoni omwe ali ndi chiopsezo chachikulu cha thrombosis, nthawi zambiri mumagulu othandizira kwambiri (omwe amalephera kupuma komanso / kapena matenda amtundu wa kupuma komanso / kapena kulephera kwa mtima), mlingo wa nadroparin umadalira kulemera kwamthupi la wodwalayo ndipo walembedwa patebulo pansipa. Mankhwalawa amaperekedwa 1 nthawi / tsiku. Nadroparin imagwiritsidwa ntchito nthawi yonse ya chiwopsezo cha thrombosis.

Muzochitika zomwe chiopsezo cha thromboembolism chokhudzana ndi mtundu wa opaleshoni (makamaka ndi opaleshoni ya oncological) ndi / kapena ndi mawonekedwe a wodwalayo (makamaka ndi mbiri ya matenda a thromboembolic) chikuwoneka kuti chikuwonjezeka, mlingo wa 2850 ME (0.3 ml) ndi wokwanira, koma mlingo uyenera kukhazikitsidwa aliyense payekhapayekha.

Kutalika kwa chithandizo. Kuchiza ndi Fraxiparin kuphatikiza njira zamwambo zamankhwala am'munsi zopitilira kumapeto ziyenera kupitilizidwa mpaka ntchito ya wodwala ibwezeretsedwe kwathunthu. Opaleshoni yayikulu, nthawi yogwiritsira ntchito Fraxiparin imafika masiku 10 osagwirizana ndi vuto la venous thromboembolism lomwe limakhudzana ndi machitidwe a wodwala. Ngati chiwopsezo cha zovuta za thromboembolic chitha kupezeka nthawi yovomerezeka itatha, chithandizo cha prophylactic chiyenera kupitilizidwa, makamaka ndi anticoagulants mkamwa.

Komabe, kufunikira kwakanthawi kachipatala kwamanthawi yayitali okhala ndi heparin ochepa kapena michere yolimbana ndi mavitamini sikunadziwikebe.

Kupewa kwa kuchulukana kwa magazi mu njira yotulutsa magazi kunja kwa nthawi ya hemodialysis

Fraxiparin iyenera kutumikiridwa mu intravascularly mu ochepa shunt ya dialysis kuzungulira.

Odwala omwe amalandila pafupipafupi hemodialysis magawo, kupewa kuphatikizika kwa gawo loyeretsa la extracorporeal kumatheka pobweretsa gawo loyambirira la 65 IU / kg mu mzere woloza kumaso kwa dialysis kuzungulira koyambirira kwa gawo.

Mlingo, womwe umagwiritsidwa ntchito ngati jekeseni imodzi yam'mimba yosungirako, umangofunika kwa magawo a dialysis osaposa maola 4. Pambuyo pake, mlingowo ungathe kukhazikitsidwa malinga ndi yankho la wodwalayo, lomwe limasiyana kwambiri.

Mlingo wa mankhwalawa malinga ndi kulemera kwa thupi amaperekedwa pagome.

Ngati ndi kotheka, mlingo umatha kusintha molingana ndi momwe matenda ena alili komanso momwe alili. Odwala omwe ali ndi chiopsezo chowonjezeka magazi, magawo a dialysis amatha kuchitidwa mwa kuchepetsa mlingo wa mankhwalawa 2 times.

Chithandizo cha Deep Vein Thrombosis (DVT)

Kukayikira kulikonse kwa mitsempha yayikulu ya mitsempha kuyenera kutsimikiziridwa mwachangu ndi mayeso oyenera.

Pafupipafupi kugwiritsa ntchito mankhwalawa ndi 2 jakisoni / tsiku ndi gawo la maola 12.

Mlingo umodzi wa Fraxiparin ndi 85 ME / kg.

Mlingo wa Fraxiparin malinga ndi kulemera kwa thupi kwa odwala omwe ali ndi thupi loposa 100 kg kapena ochepera 40 kg sizinadziwike. Odwala omwe ali ndi thupi loposa 100 kg, mphamvu ya LMWH imatha kuchepetsedwa. Komabe, odwala omwe ali ndi zosakwana makilogalamu 40, ngozi ya kukha magazi imatha kuchuluka. Zikatero, kuyang'anira kwapadera kumafunikira.

Mlingo woyenera umaperekedwa pagome.

Kutalika kwa chithandizo. Chithandizo cha LMWH chiyenera kusinthidwa mwachangu ndi anticoagulants pakamwa, pokhapokha ngati zotsalazo ndizotsutsana. Kutalika kwa mankhwalawa kwa LMWH sikuyenera kupitilira masiku 10, kuphatikiza nthawi yosinthira kwa othandizira a vitamini K, kupatula nthawi zina pakakhala zovuta kukhazikika kwa MHO. Chifukwa chake, chithandizo cha mankhwala opatsirana pakamwa chiyenera kuyambitsidwa mwachangu.

Chithandizo cha kusakhazikika kwa angina pectoris / myocardial infarction popanda pathological Q wave pa ECG

Fraxiparin imayendetsedwa mosavomerezeka pa 86 ME / kg 2 kawiri / tsiku (ndi maola 12) osakanikirana ndi acetylsalicylic acid (mulingo woyamwa wa 75 mg 25 mg pambuyo pa mlingo woyambirira wa 160 mg).

Mlingo woyamba wa 86 ME / kg umathandizidwa ndi iv-bolus - ndiye muyezo womwewo s / c. Kutalika kwa chithandizo ndi masiku 6 mpaka wodwala atakhazikika.

Mlingo wa Fraxiparin kutengera kulemera kwa thupi zimaperekedwa pagome.

Pofuna kupewa thrombosis mwa odwala omwe amalephera kupweteka aimpso (CC ≥ 30 ml / min ndi kuchepetsedwa kwa mankhwalawa safunikira. Kwa odwala omwe amalephera kwambiri aimpso, CC, mlingo uyenera kuchepetsedwa ndi 25%.

Mankhwalawa thromboembolism, angina osakhazikika ndi myocardial infarction popanda pathological Q funde mwa odwala omwe ali ofatsa komanso olimbitsa aimpso kulephera, mlingo uyenera kuchepetsedwa ndi 25%. Nadroparin imaperekedwa kwa odwala omwe ali ndi vuto laimpso.

Malangizo a kayendetsedwe ka mankhwala

Ndikofunikira kulowa m'malo opatsirana mwa wodwalayo ndikumata kwa gawo lachiberekero la anterolateral kapena lamba lachiberekero, mbali ya kudzanja lamanzere. Adaloledwa kulowa ntchafu.

Pofuna kupewa kuwonongeka kwa mankhwalawa pogwiritsa ntchito syringes, thovu la mpweya sayenera kuchotsedwa jakisoni.

Singano iyenera kuyikidwira paliponse, osati pakona, kuzikongoletsa pakhungu, komwe kali pakati pa chala chachikulu ndi chofundira mpaka kumapeto kwa yankho. Osapukuta tsamba la jakisoni mutatha jakisoni. Ma syringe omaliza amapangidwa kuti asankhe mlingo kutengera kulemera kwa thupi la wodwalayo.

Pambuyo popereka mankhwala, singano yodzitetezera singano iyenera kugwiritsidwa ntchito:

• akugwirizira syrinji yomwe imagwiritsidwa ntchito mdzanja limodzi ndi nkhani yotchinjiriza, ndi dzanja linalo koka wogwira kuti atulutsire lambuyo ndikutsegula chophimba kuteteza singano mpaka itadina. Singano yomwe imagwiritsidwa ntchito imatetezedwa kwathunthu.

Zotsatira zoyipa

Zomwe zimachitika:

• Nthawi zambiri - mapangidwe a hematoma yaing'ono subcutaneous pamalo a jakisoni,
• Nthawi zina, maonekedwe a mafupa amaukondo omwe satanthauza heparin encapsulation, omwe amasowa patadutsa masiku angapo, amawonedwa
• kawirikawiri - khungu necrosis (nthawi zambiri limayambitsidwa ndi purpura kapena malo ena owopsa a erythematous, omwe mwina satha kuyenda ndi zizindikiro wamba,
• Zikatero, chithandizo chiyenera kuyimitsidwa nthawi yomweyo.

Kuchokera pakupanga magazi:

• Mukamagwiritsa ntchito mankhwalawa muyezo waukulu, magazi amtundu wosiyanasiyana amatha kutheka (mwa odwala omwe ali pachiwopsezo china).

Kuchokera ku hemopoietic system:

• akagwiritsidwa ntchito muyezo waukulu, thrombocytopenia (mtundu I), womwe nthawi zambiri umazimiririka mankhwala ena
• kawirikawiri - eosinophilia (kusintha pambuyo povomoka mankhwala),
• Nthawi zina, immune thrombocytopenia (mtundu II), wophatikizidwa ndi ochepa komanso / kapena venous thrombosis kapena thromboembolism.

Zina:

• kuchuluka kwakanthawi kochepa kwa ntchito ya chiwindi michere (ALT, AST),
• osati kawirikawiri - thupi lawo siligwirizana, hyperkalemia (odwala oyembekezera),
• Nthawi zina - anaphylactic zimachitika, priapism.

Contraindication

• Zizindikiro za kutuluka magazi kapena chiopsezo chotaya magazi chifukwa chodwala hexpasis, kupatula DIC, osati chifukwa cha heparin,
• organic kuwonongeka ndi chizolowezi kutaya magazi (mwachitsanzo, zilonda zam'mimba kapena zilonda zam'mimba),
• kuvulala kapena kuchitapo kanthu kwa opaleshoni yayikulu
• septic endocarditis,
• intracranial hemorrhage,
• kulephera kwambiri kwaimpso (CC imafotokozedwa mosamala mu thrombocytopenia (mbiri).

Mimba komanso kuyamwa

Kugwiritsa ntchito nadroparin panthawi yapakati sikulimbikitsidwa. Funso loti lingathe kupereka mankhwalawa limasankhidwa ndi adokotala pokhapokha pakuwunikira mozama kuopsa komwe kungakhalepo ndi chithandizo chamankhwala.

M'maphunziro oyesera, zotsatira za teratogenic kapena fetotoxic za nadroparin sizinakhazikitsidwe. Zambiri pamadongosolo a nadroparin kudzera pazotchingira zina mwa anthu ndizochepa.

Pakalipano deta yosakwanira pakugawidwa kwa nadroparin ndi mkaka wamawere. Pankhaniyi, kugwiritsa ntchito nadroparin pa mkaka wa m'mawere sikulimbikitsidwa.

Gwiritsani ntchito ntchito yolakwika yaimpso

Chithandizo:

• ndi magazi ochepa, monga lamulo, ndikokwanira kuchedwetsa kuyamwa kwa mankhwalawa. Kuwerengera kwa mapulaneti ndi magawo ena othandizira magazi kuyenera kuyang'aniridwa.

Nthawi zina, kugwiritsa ntchito protamine sulfate kumawonetsedwa, komabe muyenera kukumbukira kuti kugwira ntchito kwake kumakhala kotsika kwambiri poyerekeza ndi heparin yopanda mankhwala. Kuthandiza / chiopsezo cha protamine sulfate ziyenera kuyesedwa mosamala chifukwa cha zotsatira zake zoyipa (makamaka chiwopsezo cha anaphylactic shock). Ngati lingaliro lipangidwe kugwiritsa ntchito protamine sulfate, ndiye kuti liyenera kutumizidwa pang'onopang'ono iv. Mlingo wothandiza umatengera mlingo wa heparin (protamine sulfate pa mlingo wa magawo 100 a antiheparin amagwiritsidwa ntchito kuti athetse mphamvu ya 100 ME anti-XA factor ya LMWH), nthawi idapita pambuyo pa kuperekedwa kwa heparin (ndikuchepetsa mphamvu ya mankhwalawa). Komabe, sizingatheke kusokoneza ntchito ya anti-Xa chinthu. Kuphatikiza apo, zodabwitsa za mayamwidwe a NMH ndizomwe zimayambitsa kusakhalitsa kwa protamine sulfate; motere, zitha kukhala zofunikira kugawa mlingo wake jekeseni angapo (2-4) patsiku.

Kuyanjana kwa mankhwala osokoneza bongo

Chiwopsezo cha kukhala ndi hyperkalemia chikuwonjezereka ndikugwiritsa ntchito Fraxiparin mwa odwala omwe amalandila mchere wa potaziyamu, zothetsera za potaziyamu, ACE inhibitors, angiotensin II receptor antagonists, NSAIDs, heparins (ochepa maselo kapena osagwirizana), cyclosporine ndi tacrolimus, trimethopopus.

Fraxiparin ikhoza kuyambitsa zotsatira za mankhwala omwe amakhudza hemostasis, monga acetylsalicylic acid ndi ena a NSAID, othandizira a vitamini K, fibrinolytics ndi dextran, zomwe zimapangitsa kuti izi zitheke.

Mapulogalamu obwezeretsera a platinamu (kupatula acetylsalicylic acid ngati mankhwala a analgesic ndi antipyretic, i.e. pa mlingo woposa 500 mg, NSAIDs):

• abciximab, acetylsalicylic acid ngati antiplatelet agent (i.e. pa mlingo wa 50-300 mg) pazowonetsa zamtima ndi zamitsempha, zipatso za beraprost, clopidogrel, eptifibatide, iloprost, ticlopidine, tirofiban zimawonjezera mwayi wokhetsa magazi.

Fraxiparin: ndi chiyani?

Fraxiparin ndi mankhwala omwe amachepetsa magazi kutsekeka ndikuchepetsa mwayi wa mtima.

Kupanga kwakukulu kwa mankhwalawa kumaphatikizapo chinthu chopangidwa kuchokera mkati mwa ng'ombe.

Mankhwalawa amalimbikitsa kuchepa kwa magazi ndikuwonjezera kukondoweza kwa ziwalo zam'magazi, osakhudza kugwira ntchito kwawo.

Gulu la mankhwala

Zili ndi kuwongolera zochita za anticoagulants (heparins) zamagulu ochepa olemera.

Ili ndiye mndandanda wa mankhwala omwe amakhudza hemostasis dongosolo, lomwe limayambitsa magazi kuundana.

Kuphatikiza apo, ali ndi cholinga chopewa mapangidwe am magazi omwe amachititsa zotupa zamatumbo a atherosulinotic.

Ma heparin ocheperako olemera kwambiri ndi amakono kwambiri ndipo ali ndi zabwino zingapo: kuyamwa mwachangu, kuchitapo kanthu kwa nthawi yayitali, mphamvu yowonjezera. Zotsatira zake, mlingo wa mankhwalawa kuti mupeze zotsatira zabwino kwambiri umachepetsedwa.

Chodabwitsa cha Fraxiparin ndikuti kuphatikiza pa kuchitapo kwake kwakukulu, imakhala ndi anti-yotupa, imachepetsa cholesterol yamagazi ndikuwongolera kuyenda kudzera m'mitsempha yamagazi.

Kuperewera kwa mankhwala kumakhala pafupifupi kwathunthu (kuposa 85%). Zothandiza kwambiri mu 4-5 maola ndi mankhwala, osaposa masiku 10.

Zomwe zimasankhidwa Fraxiparin: Zizindikiro

Fraxiparin amagwiritsidwa ntchito pochita zachipatala pochiza komanso kupewa matenda otsatirawa:

• thromboembolism - pachimake kufalikira kwamitsempha yamagazi ndi thrombus,
• thromboembolic zovuta pa opaleshoni ndi zamankhwala othandizira odwala omwe ali pachiwopsezo,
• pa hemodialysis ndondomeko (owonjezera magazi kuyeretsa aakulu aimpso kulephera),
• ndi chakhazikika cha angina ndi chofufumitsa chamkati,
• Pamene mukubereka mwana wosabadwayo pambuyo pa IVF,
• pa opaleshoni iliyonse odwala amadwala magazi.

Fraxiparin ndi chinthu champhamvu. Sizingagwiritsidwe ntchito mwanjira iliyonse popanda kuvomerezedwa ndi katswiri.

Kodi Fraxiparin adalembera IVF?

Njira yakukula kwa magazi imatha kuchitika mwa amuna ndi akazi onse. Komabe, kwa onse awiri, izi sizomwe zimachitika.

Mwa akazi, njirayi imawonedwa pafupipafupi, chifukwa mwachilengedwe magazi awo amalowerera kwambiri kuti asatenge msambo.

Pa nthawi ya pakati, dongosolo lonse loyenda magazi limakakamizidwa kuti lizolowere zochitika zomwe zilipo: kuchuluka kozungulira magazi ndipo, motero, maukonde onse amitsempha yamagazi amawonjezeka. Pa nthawi yoyembekezera, kuthira magazi kumatha kukhala vuto lenileni, kumakhudza kwambiri thanzi la mayi.

Kuphatikiza apo, asanabadwe, magaziwo amakhala akhama kwambiri momwe angathere kuti magazi asatayike kwambiri, zomwe zingayambitse ngozi ya moyo wa mayi. Komabe, Fraxiparin sinafotokozeredwe nthawi yapadera, popeza thupi limasintha pang'onopang'ono munthawi yokonzekera.

Ndi njira ya IVF, mkazi amakhala ndi nthawi yovuta kuposa kukhala ndi pakati.

Kukula kwa magazi kumakhala kovuta chifukwa cha mphamvu ya mankhwala a mahomoni, popanda popanda umuna wabwino. Zotsatira zake, pamakhala ngozi ya magazi, omwe amatha kuvulaza mayi ndi mwana. Pofuna kupewa izi, anticoagulants ndi mankhwala.

Pa mimba ndi IVF, Fraxiparin ndi mankhwala:

• pakuchepa magazi,
• popewa kutsekeka kwamitsempha yamagazi ndi mapangidwe a thrombotic,
• kamangidwe kabwino ka thonje, kamene kamapangitsa kusintha kwa zinthu kuchokera mthupi la mayi kupita kwa mwana wosabadwayo,
• kukhazikitsidwa koyenera ndi kumalumikiza kwa mluza.

Pakukonzekera mwana kutenga pakati pogwiritsa ntchito njira ya IVF, ma anticoagulants amakhala ofunika kwambiri, ndipo kugwiritsa ntchito mankhwalawa kumatha kupitilira nthawi yonse ya bere komanso pakapita nthawi yobereka.

Malangizo ogwiritsira ntchito Fraxiparin

Mankhwala amatanthauza anticoagulants mwachindunji, i.e. zimakhudza mwachindunji zigawo za kuphatikizika kwa magazi, osati machitidwe omwe amasokoneza mapangidwe a ma enzymes. Malinga ndi malangizo ogwiritsira ntchito, jekeseni yogwira ntchito ndi jekeseni wa heparin (acid acid sulfure-glycosaminoglycan). Heparin imagwiritsidwa ntchito kuchipatala kuchitira kuti magazi asachulukane (mwachitsanzo, pochita opaleshoni) komanso thrombosis.

Kupanga ndi mawonekedwe a kumasulidwa

Fraxiparin imapezeka mu ma syringe omwe ali ndi yankho lomveka bwino ndi tinthu tating'onoting'ono. Singano ya hypodermic ndiyifupi komanso yocheperako kuti muchepetse kupweteka pakubaya. Kamangidwe ka mankhwala ndi mawonekedwe a kumasulidwa akuwonetsedwa pagome:

Kashiamu Nadroparin (IU Anti-Ha)

Madzi a mandimu (calcium hydroxide solution) kapena kuchepetsa hydrochloric acid

Chowonda cha jakisoni (ml)

Mu kuchuluka kofunikira

1 kapena 5 matuza mu katoni okhala ndi ma syringes awiri a 0.3 ml

Mu kuchuluka kofunikira

1 kapena 5 matuza mu katoni okhala ndi ma syringe amtundu wa 2 0,4 ml

Mu kuchuluka kofunikira

1 kapena 5 matuza mu katoni yamakatoni okhala ndi ma syringe a 2 0,6 ml

Mu kuchuluka kofunikira

1 kapena 5 matuza mu katoni yamakatoni okhala ndi ma syringe a 2 0,8 ml

Mu kuchuluka kofunikira

1 kapena 5 matuza m'bokosi lamakatoni okhala ndi ma syringe awiri a 1 ml iliyonse

Pharmacodynamics ndi pharmacokinetics

Ntchito ya anticoagulant ya heparin imadziwika kudzera mu kukhazikitsidwa kwa puloteni yayikulu ya plasma (mapuloteni a magazi) antithrombin 3. Chofunikira chachikulu cha Fraskiparin ndi coagulant mwachindunji ndipo zotsatira zake ndikuchepetsa ntchito ya thrombin m'magazi (kuponderezana kwa factor Xa). Mphamvu ya antithrombotic ya calcium nadroparin imatheka chifukwa cha kutembenuka kwa kusintha kwa minofu ya thromboplastin, kuthamanga kwa kusungunuka kwa magazi owundana (chifukwa chakumasulidwa kwa minofu ya plasminogen) komanso kusinthidwa kwa ziwengo zamapulogalamu.

Poyerekeza ndi heparin yopanda mafuta, heparin yotsika kwambiri imakhala yochepa kwambiri pa hemostasis yoyambirira ndipo Mlingo wa prophylactic simalowetsa kuchepa kotchulidwa kwa nthawi yodziwika ya thromboplastin. Pazipita ndende yogwira mankhwala am`magazi pambuyo subcutaneous makonzedwe a mankhwala zimatheka pambuyo 4-5 maola, pambuyo mtsempha wa magazi - pambuyo mphindi 10. Metabolism imachitika kudzera mwa kufalikira komanso kuwonongedwa kwa maselo a chiwindi.

Momwe mungabayere Fraxiparin

Mankhwalawa amaperekedwa pang'onopang'ono ndi jakisoni mu minofu ya anterolateral kapena pambuyo pake pamimba. Njira yobweretsera yankho limakhala kupyoza pakhungu lomwe limakulungidwa pakati pa zala, pomwe ngodya imayambitsidwa. Zingwe za Fraxiparin pamimba zimatha kulowetsedwa ndi jakisoni mu ntchafu. Kuti mupewe chiopsezo cha thromboembolism pa nthawi ya opaleshoni, heparin imayendetsedwa maola 12 isanafike kuchitidwe ndipo maola 12 atatha, ndiye kuti jekeseni wambiri wa yankhoyo ndi mankhwala. Mlingo wotsatira zimadalira momwe wodwalayo alili ndi thupi lake:

Mlingo wa makonzedwe, ml

Chithandizo cha angina wosakhazikika

Mlingo woyambirira umaperekedwa kudzera m'mitsempha, wotsatira - maola 12 aliwonse, mosazindikira, njira ya mankhwalawa ndi masiku 10

Mankhwalawa amaperekedwa kawiri pa tsiku mpaka magawo azofunikira zamagazi akwaniritsidwa

Magazi coagulation prophylaxis pa hemodialysis

Fraxiparin imayendetsedwa kamodzi m'mitsempha musanachitike dialysis, ndikuyika magazi kwambiri, mlingo uyenera kuchepetsedwa

Malangizo apadera

Pochiza ndi mankhwala a gulu la otsika maselo owonda kwambiri, ziyenera kukumbukiridwa kuti Fraxiparin sangaphatikizidwe ndi mankhwala ena a gululi. Mankhwalawa sanapangire jakisoni wa mu mnofu. Munthawi yonse ya mankhwalawa, ndikofunikira kuyang'anira kuchuluka kwamapulatini kuti tipewe kuthekera kwa thrombocytopenia. Kwa odwala okalamba, musanagwiritse ntchito anticoagulant, tikulimbikitsidwa kuyezetsa matenda a impso.

Pa nthawi yoyembekezera

Zotsatira za kafukufuku woyeserera wa nadroparin mu nyama zinawonetsa kusakhalapo kwa zotsatira zowopsa za fetatogenic ndi fetotoxic, koma zomwe zikupezeka sizingagwiritsidwe ntchito kwa anthu, chifukwa chake, jakisoni wa heparin panthawi yoyembekezera imatsutsana. Mukamayamwa, kugwiritsa ntchito mankhwalawa kuyenera kusiyidwa chifukwa cha kuchuluka kwa zinthu zomwe zingagwire ntchito pakudutsa mkaka wa m'mawere.

Ndi umuna wa in vitro, wodwalayo amapatsidwa jakisoni wa mankhwala a mahomoni. Chifukwa chakuti mahomoni amatha kupangitsa magazi kuchulukana ndikuwonjezeranso zovuta zake, dokotala amafotokoza njira yothetsera matenda asanafike pathupi kuti muchepetse thrombosis ndikuyambitsa kulowetsedwa kwa mwana wosabadwayo.

Muubwana

Mankhwala okhala ndi hepatini sagwiritsidwa ntchito ngati ana, motero zaka za odwala zosakwana zaka 18 ndizotsutsana ndi ntchito ya anticoagulant. Sipanakhalepo kafukufuku wokhudza kugwiritsa ntchito mankhwalawa kwa ana, koma pali chokuchitikirani ndi kuperewera kwa mankhwalawa kwa ana, komwe kudachitika chifukwa chofunikira chotere. Zotsatira zomwe zapezeka chifukwa cha izi sizingagwiritsidwe ntchito ngati malingaliro.

Mowa ndi Fraxiparin Kugwirizana

Ethanol yomwe ili ndi zakumwa zoledzeretsa zimathandizira kupanga mapangidwe amwazi ndikuwonjezera mphamvu za thromboembolic, chifukwa zinthu zowola zimapangitsa kuyatsidwa kwa calcium ndi mafuta pazitseko zamitsempha yamagazi. Kugwiritsa ntchito pamodzi mankhwala osokoneza bongo komanso kumwa moledzera kumapangitsa kuti mankhwalawo akhale osagwirizana ndi zotsatira zabwino za mankhwala.

GlaxoSmithKline, Ofesi Yoyimira, (UK)

Kuyimira
GlaxoSmithKline Export Ltd LLC
ku Republic of Belarus

220039 Minsk, Voronyansky St. 7A, cha. 400
Tel. ((375-17) 213-20-16
Fakisi: (375-17) 213-18-66