Eyona >> Iziyobisi Vs. Umhlobo >> ICoumadin vs. heparin: Umahluko, ukufana, kwaye kukuphi okungcono kuwe

ICoumadin vs. heparin: Umahluko, ukufana, kwaye kukuphi okungcono kuwe

Iziyobisi Vs. Umhlobo

Unyango lwe-Anticoagulation ludlala indima ebalulekileyo kulawulo lweemeko ezinzulu ezinje nge-atrial fibrillation, venous thromboembolism, kunye nokubekwa kwentliziyo kwevalvement placement. Amayeza e-anticoagulant Coumadin kunye neheparin anceda ekulawuleni nasekuthinteleni ukwenziwa kwamahlwili egazi anokubulala kwezi meko.

I-Vitamin K licandelo eliphambili kwindlela yokwenziwa kwe-clot. Iyadingeka kulungelelwaniso lwezinto ezisebenzayo zokunqanda ii-II, VII, IX, kunye no-X. Nje ukuba isetyenziselwe ukuhlanganiswa kwezi zinto zijija igazi, ivithamin K iyacinywa kwaye kufuneka iphinde yenziwe ivithamin K i-epoxide reductase complex 1 (VKORC1) ukuze uqhubeke nokuthatha inxaxheba kwinkqubo yokubumba. I-Coumadin inqanda icandelo le-VKOR complex kwaye ngaloo ndlela inegalelo ekupheliseni ivithamin K emzimbeni, ocothisa amandla omzimba okwenza amahlwili.

IHeparin isebenza ngokuzibophelela kwiprotein antithrombin III ethi emva koko isebenzise i-thrombin kunye nezinye izinto ezijiyileyo, okona kubaluleke kakhulu xa. La manyathelo athintela ukuguqulwa kwe-fibrinogen ukuya kwi-fibrin, inyathelo eliphambili ekubumbeni kwe-clot. Ngokunciphisa ukubunjwa kwe-fibrin, i-heparin iyancipha ukubunjwa komzimba.

Yintoni umahluko ophambili phakathi kweCoumadin kunye neheparin?

I-Coumadin sisiyobisi esigqirha esaziwa njengesiqhelo, i-warfarin, okanye ngamanye amaxesha i-Jantoven. Isetyenziselwa ukuthintela ukwenziwa kwamahlwili egazi kwiimeko ezinje nge-atrial fibrillation, stroke, infarction ye-myocardial, kunye ne-venous thromboembolism. Iyafumaneka njengecwecwe lomlomo kwiidosi ezahlukeneyo ukusuka kwi-1mg ukuya kwi-10mg kwithebhulethi nganye. Ngelixa eCoumadin, abaguli kufuneka bangenise kuvavanyo lweprothrombin (PT) oluchazwe njengeRatio yesiqhelo yaMazwe ngaMazwe (INR) ukumisela ukuba ngaba idosi yesigulana ifanelekile kusini na. I-Warfarin ayisetyenziswanga kwizigulana ezingaphantsi kweenyanga ezi-4 ubudala ngenxa yemicimbi yezolawulo kunye nezinto ezinokubakho zezinto ezingafumanekiyo ezinokuchaphazela ubuntununtunu.

IHeparin sisiyobisi esigqirha esisetyenziswa kakhulu kwizigulana ezingalaliswayo. Isetyenziselwa ukuthintela ukwenziwa kwamahlwili egazi kwiimeko ezinje nge-venous thrombosis, embolism ye-pulmonary, kunye ne-atrial fibrillation. Isetyenziselwa ukuthintela ukwakheka kwehlwili ngexesha leenkqubo ezibandakanya intliziyo kunye nemithambo yegazi. I-heparin ifumaneka kwiifom zezisombululo ezahlukeneyo ngenaliti efakwa ngaphakathi okanye kwi-infusions. Kukho ulwakhiwo oluthile lweeherparin ezijolise kuphela kumgca wokugungxula umgca wokuthintela ukwakheka kwehlwili emgceni. Oku kubizwa ngokuba yi-heparin lock flush, kwaye oku kuqulunqwa akufuneki kusetyenziselwe enye injongo. IHeparin inokusetyenziselwa abaguli bayo nayiphi na iminyaka, kodwa ukubek'esweni kufutshane kuyafuneka.

Umahluko ophambili phakathi kweCoumadin kunye neHeparin
	Coumadin	IHeparin
Iklasi yeziyobisi	I-Anticoagulant	I-Anticoagulant
Uhlobo lweBrith / generic	Brand kunye generic ziyafumaneka	Brand kunye generic ziyafumaneka
Ngubani igama eliqhelekileyo? Ngubani igama lophawu?	IWarfarin Coumadin	IHeparin
Zeziphi iifom eza nalo iziyobisi?	Ithebhulethi (amandla amaninzi)	Isisombululo ngenaliti okanye ukumnika (ubuninzi beendawo ezikhoyo)
Ithini idosi esemgangathweni?	Uninzi lwezigulana ziqala kwi-5 mg yonke imihla, kodwa idosi yesondlo ixhomekeke kwi-INR yesigulana ngasinye	Isigulana esikhulileyo esiqhelekileyo siya kufumana idosi yokulayisha yeeyunithi ezingama-5 000 zilandelwe ngama-20,000 ukuya kuma-30,000 kwiiyunithi ngaphezulu kweeyure ezingama-24 kufakelo oluqhubekayo
Lude kangakanani unyango oluqhelekileyo?	Ubuncinci beenyanga ezi-3, kodwa isenokungabikho ngokuxhomekeke ekubonakalisweni	Ngokwesiqhelo iintsuku ezimbalwa, ukuya kwiveki
Ngubani oqhelekileyo usebenzisa amayeza?	Abantu abadala	Abantu abadala

Iimeko zonyango lweCoumadin kunye neheparin

I-Coumadin isetyenziselwa ukuthintela nokunyanga i-venous thromboembolism kunye ne-pulmonary embolism kunye neengxaki ze-coagulation ezinxulunyaniswa ne-atrial fibrillation kunye ne-mechanical valve replacement. I-Coumadin ikwasetyenziselwa ukuthintela iingxaki ezinxulumene nokuqina ezinokuthi zilandele isifo se-myocardial infarction okanye isifo sentliziyo.

IHeparin ikwasetyenziselwa ukukhusela nokunyanga i-venous thromboembolism kunye ne-pulmonary embolism kunye neengxaki zokuqina ezinxulunyaniswa ne-atrial fibrillation. Ukongeza, i-heparin isetyenziselwa ukuthintela ukubambeka kugqirha wentliziyo, utofelo-gazi kunye neenkqubo zedialysis.

Imeko	Coumadin	IHeparin
I-venous thromboembolism	Ewe	Ewe
Ukudibanisa iipulmonary	Ewe	Ewe
I-fibrillation ye-Atriya	Ewe	Ewe
Utshintsho lweevalve zoomatshini	Ewe	Ewe
Ubunzima be-post-myocardial infarction obuhambelana nokuqina	Ewe	Hayi
Ungenelelo ngoncedo lwe-coronary (angioplasty)	Hayi	Ewe
Utofelo-gazi	Hayi	Ewe
Uxilongo	Hayi	Ewe

Ngaba i-Coumadin okanye i-heparin isebenza ngakumbi?

I-Coumadin kunye ne-heparin baneyantlukwano ebanika indawo nganye ebalulekileyo kunyango, amaxesha ngamaxesha kwisigulana esinye.

Ukupheliswa kwesiqingatha sobomi kunye nexesha lokuphakama koxinzelelo zizinto ezibaluleke kakhulu zeklinikhi ekumiseleni indlela kunye nexesha lokusebenzisa ichiza ngalinye. I-Coumadin ifikelela kumanqanaba aphezulu e-plasma ukusuka kwithamo elinye malunga neeyure ezi-4, kunye nesiqingatha sobomi esimalunga neeyure ezingama-40. Ngenxa yezinto ezininzi ezinokwahluka kwisigulana ngasinye, kunokuthatha iintsuku ukuya kwiiveki ukufikelela kwi-INR yonyango. I-Heparin ifikelela kumanani aphezulu e-plasma kwiiyure ezi-2 ukuya kwezi-4, kunye nesiqingatha sobomi malunga nemizuzu engama-60-90.

Inkqubo ye- izikhokelo kulawulo lwe-vein thrombosis enzulu (i-DVT) kunye ne-pulmonary embolism kwiintlobo ezininzi zesigulana ziya kuncoma ukusetyenziswa kokuqala kwe-heparin ngenxa yokuqalisa kwayo ngokukhawuleza. Ukusebenza ngokunyanga kufezekiswa ngokulawula idosi yokulayisha elandelwa yidosi yesondlo. Oku kuyaqhubeka ngelixa unyango lwe-Coumadin luqalisiwe, kwaye de kube i-INR yesigulana yonyango. Oku kungathatha iintsuku ezisi-7 ukuya kwezi-10. I-Heparin ngokubanzi ifuna ukulawulwa kwindawo yokunyanga, kodwa isigulana singaya ekhaya nje ukuba batshintshele eCoumadin.

Ngumboneleli wezempilo kuphela onokumisela ukuba loluphi unyango, okanye indibaniselwano yonyango efanelekileyo kwisigulana ngasinye. Ababoneleli kufuneka bathathele ingqalelo uninzi lwezinto ezithile zesigulana, ezinje ngembali yeziganeko zokunqanda igazi, ubudala, unyango lwangaphambili, kunye nembali yeemeko ezinje nge-heparin-indened thrombocytopenia.

Ukufunyanwa kunye nokuthelekiswa kweendleko zeCoumadin vs. heparin

Uninzi lweMedicare kunye nezicwangciso zeinshurensi zorhwebo zigubungela iCoumadin, kunye / okanye uhlobo lwayo oluqhelekileyo warfarin. Ixabiso eliphakathi lokuthengisa i-Coumadin linokuvela kwi-80 yeedola ukuya kwi-120 yeedola. Unokufumana i-warfarin malunga ne- $ 10 nge-Coupon eyodwa ye-SingleCare.

IHeparin ihlala inikwa kwisibhedlele kwaye ihlala igutyungelwe ngaphantsi Icandelo leMedare B . Kwizigulana ezingezizo ezonyango, igutyungelwa yinshurensi yezonyango xa ithathwa njengefanelekileyo kwaye iyimfuneko. Isigulana esiphuma kwindleko yepokotho siya kuxhomekeka kwizinto ezininzi kubandakanya nokuba ngaba badibene nokutsalwa kwabo kwaye ukuba banegalelo elongezelelweyo. Ukuba isigulana sifumanisa ukuba iHeparin yabo ayigutyungelwanga, banokukhuphela isigqebhezana kwaye bahlawule njenge- $ 45 yonyango.

	Coumadin	IHeparin
Ngokuqhelekileyo ihlawulwa yi-inshurensi?	Ewe	Ewe
Ngokuqhelekileyo igutyungelwe yiMedicare?	Ewe	Ewe, Icandelo B
Umthamo osemgangathweni	30, 5 mg idosi	25 ml, iyunithi ye-5000 / ml
I-Medicare copay eqhelekileyo	Iyahluka	Iyahluka
Ixabiso elilodwa	$ 4- $ 14	Iidola ezingama-45- $ 65

Iziphumo eziqhelekileyo ezichaphazelekayo zeCoumadin kunye neheparin

Eyona ixhaphakileyo imiphumela Zombini iCoumadin kunye neheparin kukopha okanye ukopha kakhulu. Ezinye iimpawu zokopha kunokuba nzima ukuzibona, kodwa ezinye zeempawu ezicace gca zibandakanya ukutyumka ngokulula, ukuphuma kweempumlo, ukopha kwiintsini, umchamo omdaka okanye umbala omdaka, kunye negazi elisweni. Ukuba isigulana sizimisele ukopha, ukurhoxa kwichiza kuyafuneka, nokuba yeyethutyana okanye ixesha elide.

I-Heparin-induced thrombocytopenia (HIT) ixelwe kwi-1-2% yezigulana ezinikwe i-heparin. Oku kwehla kakhulu kubalo lweplatelet kungakhokelela kwiingxaki ezinzulu ezinjenge-necrosis yethishu kunye nokubola.

Kukho ezinye iingxaki kunye neziphumo ebezingalindelekanga ezivela kunyango lweCoumadin okanye lweheparin. Ugqirha okanye usokhemesti unokubonelela ngoluhlu olupheleleyo lweziphumo ebezingalindelekanga.

	Coumadin	IHeparin
Imiphumela	Iyasebenza?	Rhoqo	Iyasebenza?	Rhoqo
Ukopha	Ewe	1-10%	Ewe	1-10%
I-Gangrene / Ulusu lweNecrosis	Ewe	<1%	Ewe	<1%
I-Thrombocytopenia	Hayi		Ewe	≤30%
HIT	Hayi		Ewe	1-2%

Olu isenokungabi luluhlu olupheleleyo lweziganeko ezimbi. Nceda uqhagamshelane nogqirha okanye usokhemisti uluhlu olupheleleyo.
Umthombo: DailyMed ( Coumadin ), Yonke imihla ( heparin ).

Ukudibana kweziyobisi kweCoumadin vs. heparin

I-Coumadin idityaniswe yi-cytochrome P450 enzymes, ikakhulu ii-subtypes 2C9, 1A2, kunye ne-3A4. I-inhibitors yezi enzymes ngokwenyani zonyusa amanqanaba e-Coumadin, ke ngoko yonyusa i-INR yesigulana kwaye yonyusa umngcipheko wokopha. Imizekelo yezi zinhibitors ze-enzyme ibandakanya ii-antifungals ezifana ne-fluconazole, kunye neziyobisi ezithandwayo ze-cholesterol, i-atorvastatin. Ukunyanzeliswa kwe-enzyme kuya kwehlisa amanqanaba e-Coumadin, enokuthi yenze i-INR yesigulana kunye nokunyusa ukugxothwa komsitho we-thrombotic. Imizekelo ye-inducers inducers ibandakanya amayeza okulwa nokuthimba i-carbamazepine kunye ne-phenobarbital.

Iziphumo ze-heparin zinokubakho ngamachiza e-antiplatelet njenge-NSAID. Ibuprofen iya kuba ngumzekelo. Iziphumo zeHeparin zinokuhla ngokudibana kunye namayeza aqhelekileyo njenge-doxycycline.

Le theyibhile ilandelayo ayilo luhlu olubandakanya konke ukuhlangana. Umboneleli wakho wezempilo unokubonelela uluhlu olubanzi kunye nolwazi olongezelelweyo kwintsebenzo nganye.

Iziyobisi	Iklasi yeziyobisi	Coumadin	IHeparin
Amiodarone Ipropafenone	Ulwaphulo lomculo	Ewe	Hayi
IFluconazole Itraconazole Ketoconazole Miconazole Voriconazole	Unyango lokungunda	Ewe	Hayi
IPhenobarbital ICarbamazepine	I-Anticonvulsant	Ewe	Hayi
Cimetidine Famotidine Iranididine	IiAntacids	Ewe	Hayi
Ciprofloxacin I-Norfloxacin	I-Fluoroquinolone Antibiotic	Ewe	Hayi
Clarithromycin Erythromycin I-Telithromycin	I-Macrolide Antibiotics	Ewe	Hayi
Uncedo I-minocycline	Itetracycline Antibiotic	Hayi	Ewe
Atorvastatin IFluvastatin Simvastatin	I-HMG Co-A yokuNciphisa iiNhibitors (iiStatins)	Ewe	Hayi
Ukudibana kwe-Estrogen kunye neProgestin	Izinto zokucwangcisa ngomlomo	Ewe	Ewe
Apixaban IRivaroxaban powder Edoxaban	Igazi elincinci	Hayi	Ewe
Ibuprofen INaproxen	NSAID	Ewe	Ewe
Umgqube Meloxicam	I-Cox II Inhibitor	Ewe	Ewe

Izilumkiso zeCoumadin kunye neheparin

I-Coumadin kunye ne-heparin zinokonyusa ukwenzeka kwesigulo sokopha. Amanye amachiza anokunyusa amathuba oku kwenzeka. Izigulana eziseCoumadin kufuneka zihlolwe rhoqo i-INR. Ukutya kakhulu ivithamin K, equlethwe kukutya okuninzi okufana nemifuno eluhlaza, kunokunciphisa ukusebenza kweCoumadin. Izigulana kufuneka zigcine ukutya okuthe rhoqo kwemihla ngemihla kweVitamin K ngelixa ikwiCoumadin ukuze kugcinwe i-INR yonyango. I-Coumadin iyaphikiswa xa ukhulelwe.

I-Heparin-induced thrombocytopenia yenzeka nge-1% ukuya kwi-2% yezigulana kwaye sisiganeko esibi esikhokelela ekutshatyalalisweni kweeplatelets. Oku kunokukhokelela kwi-necrosis yolusu kunye nesikhumba ukuba ayibanjwanga ngexesha.

Imibuzo ebuzwa rhoqo malunga neCoumadin vs. heparin

Yintoni iCoumadin?

I-Coumadin sisiyobisi somlomo se-anticoagulant esisetyenziselwa unyango kunye neprophylaxis ye-venous thrombosis kunye ne-pulmonary embolism. Isetyenziselwa ukulawula iminyhadala yokujiya enxulunyaniswa nefayibrari ye-atrial kunye nokubekwa kwentliziyo emzimbeni. Ithathwa ngomlomo ngesiqhelo kanye ngemini, kwaye abaguli kufuneka babe ne-INR yabo ijongwe rhoqo ukuqinisekisa ukuba idosi yabo yeCoumadin ilungile.

Yintoni ihipparin?

I-Heparin sisiyobisi se-anticoagulant esinikwa ngaphakathi ngaphakathi kwisibhedlele. Isetyenziselwa unyango kunye neprophylaxis ye-venous thrombosis kunye ne-pulmonary embolism. Isetyenziselwa ukulawula iminyhadala yokunqanda igazi xa usenza utyando lwentliziyo kunye neevousous. Izigulana zifumana idosi yokulayisha elandelwa kukufakwa, okunokuhlala iintsuku ezininzi kuxhomekeke kunyango.

Ngaba iCoumadin kunye neherparin ziyafana?

Ngelixa i-Coumadin kunye ne-heparin zombini ziyeza, azifani. I-Coumadin sisiyobisi somlomo esisetyenziswa ikakhulu kwisimo sokugula, ngelixa i-heparin sisiyobisi esingena ngenaliti esisetyenziswa kwisibhedlele.

Ngaba iCoumadin okanye iHepparin ingcono?

Ukuqala kwesenzo sikaHeparin kukhawuleza kakhulu kuneCoumadin kodwa kufuneka kulandelwe ukufakelwa okuqhubekayo okanye inaliti rhoqo. Ke ngoko, i-heparin inokusetyenziswa kuphela kwisibhedlele. I-Coumadin inokuthatha iintsuku ezininzi ukuba isebenze kodwa ikhuselekile ukuba ingathathwa kwisimo sangaphandle. Izigulana eziseCoumadin kufuneka zixhomekeke kuvavanyo lwegazi rhoqo ukuqinisekisa ukuba i-INR yabo ikuluhlu olufanelekileyo.

Ndingayisebenzisa iCoumadin okanye iheparin ngelixa ndikhulelwe?

I-Coumadin inqumle i-placenta kwabasetyhini abakhulelweyo kwaye ibonakalisiwe ukuba ineziphumo ze-teratogenic. I-Coumadin, ke, iyaphikiswa ekukhulelweni ngaphandle kokuba isiguli sinesiphene senhliziyo okanye sisengozini enkulu yomnyhadala we-thromboembolic. IHeparin inokunikwa ngexesha lokukhulelwa njengoko ingaweli i-placenta, nangona kunjalo, uninzi lweengcali zikhetha i-heparin yesisindo esisezantsi (LMWH) ekukhulelweni okunje ngeLovenox (enoxaparin).

Ndingayisebenzisa iCoumadin okanye iheparin ngotywala?

Akukho kuphikisana nokusetyenziswa kotywala kweCoumadin okanye i-heparin. Nangona kunjalo, utywala bunokuchaphazela ukusebenza kwe-hepatic kwezinye izigulana, kubangele isidingo sokujonga esondeleyo i-INR xa uthatha iCoumadin.