Mankhwala a NOAC - omwe amalowa m'malo mwa Coumadin
Ngati mumayang'ana TV, mumakhala mukuwona malonda a mankhwala atsopano a antiticoagulant (ochepa magazi) wotchedwa Pradaxa, Eliquis, Xarelto, ndi Savaysa. Zotsatsa malonda amanena kuti mankhwalawa ndi osavuta kutenga, ndi otetezeka, ndipo ndi othandiza (ngati sagwira ntchito) kuposa Coumadin (warfarin).
Ngakhale kuti zonenazi sizongoganizira, sanena nkhani yonseyi.
Mavuto ndi Coumadin
Kwa odwala omwe amafunika kutenga mankhwala a antiticoagulant (mwachitsanzo, anthu omwe ali ndi matenda a atrial , deep veous thrombosis , kapena pulmonary embolus ), kwa zaka zambiri njira yokhayo inali yogwirizana ndi Coumadin.
Kugwiritsa ntchito Coumadin mosamala komanso mogwira mtima kungakhale kovuta. Kawirikawiri ndi koyenera kuyesa magazi nthawi zambiri kuti awonetse chikhalidwe cha "coins" ("kuchepa" kwa magazi), ndipo kusintha kawirikawiri kumakhala kofunika kuti pakhale chiwerengero chokwanira. Kusintha kwa thanzi, ngakhale kudya zakudya zolakwika, kungachititse kuti magaziwo akhale "oonda kwambiri" (omwe angapangitse chiopsezo chachikulu chokha magazi), kapena "osakwanira mokwanira" (zomwe zingapangitse ngozi ya magazi). Chabwino, kutenga Coumadin ndizovuta.
Mankhwala omwe amapezeka mu malonda onsewa amachokera ku gulu latsopano la mankhwala omwe, mwa odwala ambiri, amapereka njira ina kwa Coumadin. Nthawi zambiri madokotala amanena za mankhwalawa monga NOACs - "mawu ovomerezeka omveka bwino."
Momwe NOACs Amagwira Ntchito
Mankhwala a antiticoagulant amagwira ntchito poletsa ziwalo za coagulation (zomwe zimatchedwanso kuti clotting factors) m'magazi. Zinthu zowonongeka ndi mapuloteni omwe amagwira ntchito pamodzi ndi mapulogalamu a magazi kuti apange magazi.
Coumadin amagwira ntchito poletsa vitamini K, vitamini zofunika kuti pakhale njira zingapo zofunika kwambiri.
Ndipotu kupatsa vitamini K ndi njira yabwino yothetsera mavuto a Coumadin.
The NOACs imagwira ntchito mwachindunji kuletsa zinthu zowonongeka. Pradaxa (dabigatran) imaletsa mwachindunji thrombin, yotchedwanso kuti clotting factor IIa.
Zina zomwe zilipo NOACs - Xarelto (rivaroxaban), Eliquis (apixaban), ndi Savaysa (edoxaban) - ntchito poletsa zinthu zosiyana, factor Xa.
Nchiyani Chimachititsa NOACs Kukhala "Bwino" Kuposa Coumadin?
NOACs ali ndi mwayi wapamwamba kuposa Coumadin. Zili choncho, zimapanga tizilombo toyambitsa matenda tizilombo toyambitsa matenda, choncho sitingayesedwe magazi kapena kusintha kwa mlingo. Ndipo palibe zakudya zomwe zimakhudzana ndi kutenga NOACs. Choncho kutenga NOACs kumakhala kovuta kwambiri pa moyo wa munthu kuposa kutenga Coumadin.
Kuwonjezera apo, kafukufuku wamaphunziro akusonyeza kuti NOACs ndi othandiza monga Coumadin poteteza magazi. Ndipo chiopsezo chachikulu cha kutaya mwazi kwakukulu ndi NOACS chikuwoneka kuti sichikuposa kuposa ndi Coumadin (ndipo akhoza kukhala otsika).
Kodi Zotsutsana Ndi Zomwe Zilipo?
Mwina vuto lalikulu ndiloti, mosiyana ndi Coumadin, palibe mankhwala omwe alipo pakali pano kuti mankhwalawa asinthidwe mofulumira.
Izi zikutanthauza kuti ngati chochitika chachikulu chokha magazi chikachitika, zotsatira zowopsa zingakhale zazikulu kusiyana ndi Coumadin.
Mu October, 2015 a FDA avomereza mankhwala atsopano Praxbind (idarucizumab) kuti asinthe zotsatira za Pradaxa. Kukhalapo kwa mankhwala kwa Pradaxa ndi chitukuko chofunikira.
Komabe, popeza zina zilipo NOAC mankhwala amalepheretsa chinthu china, osati chinthu chachiwiri monga Pradaxa, Praxbind samasintha zotsatira zake. Amatsutsa kwa factor Xa zizindikiro zikupangidwa.
Pradaza ndi Eliquis amafunika dosing pawiri pa tsiku, mosiyana ndi Xarelto ndi Savaysa (ndi Coumadin) zomwe zimangotengedwa kamodzi patsiku.
NOACs ndi okwera mtengo kwambiri kuposa Coumadin, ndipo mtengo ukhoza kukhala wosayenera kwa anthu omwe inshuwaransi sichikuphimba.
The NOACs sivomerezedwa kuti agwiritsidwe ntchito, mwachitsanzo, kwa odwala omwe ali ndi valve yamtima kapena omwe ali ndi mimba.
Mankhwalawa amawasokoneza kwambiri ndi impso, ndipo amafunika kuwagwiritsa ntchito mosamala kwambiri ngati ali ndi matenda a impso.
Pomalizira, popeza kuti NOACs ndi mankhwala atsopano, ndizotheka kuti zina zowonjezera zowonongeka zitha kuonekera. (Ichi ndi chiopsezo chomwe munthu amatenga, ndithudi, ndi mankhwala aliwonse atsopano.)
Kodi A NOAC Ayenera Kugwiritsa Ntchito Liti?
Kunena zoona, ili ndi funso lomwe akatswiri azachipatala akungoyamba kumene. Koma chifukwa cha zovuta zodziwika bwino za Coumadin, akatswiri ambiri akudalira kwambiri kulangiza mankhwala atsopano a antiticoagulant monga chisankho choyamba mwa anthu ambiri omwe amafunikira mankhwala osalankhula achilendo.
Mawu Ochokera
Mankhwala a NOAC amapereka njira yabwino kwa anthu omwe amafunikira mankhwala osadziwika, ndipo ambiri, ndiwo njira yabwino.
Anthu amatha kupeza madokotala akulangiza imodzi mwa mankhwala atsopano ngati ayamba kuyambitsanso kachilombo koyambitsa matendawa, ngati atakhala ndi vuto lokhazikika la Coumadin, kapena ngati atatha kumvetsera mavuto omwe angakhale nawo pa zosankha zonse) iwo enieni amasonyeza kusakondera kwa mankhwala atsopano. Komabe, anthu omwe akhala akutenga Coumadin bwinobwino - ndi kuyesa magazi mosasunthika pa miyezi yochepa - kwa miyezi yochepa kapena kutalika mwinamwake kulibwino kuti mutumikire ndi Coumadin.
> Zotsatira:
> Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran Kulimbana ndi Warfarin Odwala Odwala Matenda Aakulu. N Engl J Med 2009; 361: 1139.
> Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban Versus Warfarin Mu Nthenda Yopanda Atvalvular Atrial Fibrillation. N Engl J Med 2011; 365: 883.
> Granger CB, Alexander JH, McMurray JJ, et al. Apixaban Potsutsana ndi Warfarin Odwala Odwala Matenda Aakulu. N Engl J Med 2011; 365: 981.
> Furie KL, Goldstein LB, Albers GW, et al. Mankhwala a Oral Antithrombotic oletsa kudwala matenda osokoneza bongo Amuna omwe amatha kudwala matendawa: A Adventory Advisor for Healthcare Professionals Kuchokera ku American Heart Association / American Stroke Association. Stroke 2012.