Waukulu >> Mankhwala Osokoneza Bongo Vs. Mnzanu >> Coumadin vs. heparin: Kusiyana, kufanana, ndi zomwe zili zabwino kwa inu

Coumadin vs. heparin: Kusiyana, kufanana, ndi zomwe zili zabwino kwa inu

Mankhwala osokoneza bongo Vs. Mnzanu

Thandizo la Anticoagulation limagwira ntchito yayikulu pakuwongolera zovuta monga atribrillation ya venous, venous thromboembolism, ndi makina amagetsi a mtima. Mankhwala a anticoagulant Coumadin ndi heparin amathandizira ndikuwongolera kupangika kwa magazi omwe akhoza kupha munthawi imeneyi.

Vitamini K ndichinthu chofunikira kwambiri pakapangidwe kake. Amafunika pakuphatikizira kwa zinthu zomwe zimayambitsa kugwirana ntchito II, VII, IX, ndi X. Vitamini K ikagwiritsidwa ntchito pophatikizira magazi, vitamini K imatha ndipo iyenera kuyambiranso ndi vitamini K epoxide reductase complex 1 (VKORC1) kuti mupitilize kutenga nawo gawo popanga ma clot. Coumadin imalepheretsa gawo la VKOR complex ndipo potero limathandizira kuchepa kwa vitamini K mthupi, zomwe zimachepetsa mphamvu yapangidwe ka thupi.

Heparin imagwira ntchito pomanga puloteni antithrombin III yomwe imayambitsa ma thrombin ndi zinthu zina zotseketsa, koposa zonse Xa. Izi zimaletsa kutembenuka kwa fibrinogen kukhala fibrin, gawo lofunikira pakupanga magazi. Pochepetsa mapangidwe a fibrin, heparin imachepetsa mawonekedwe am'magazi mthupi.

Kodi pali kusiyana kotani pakati pa Coumadin ndi heparin?

Coumadin ndi mankhwala akuchipatala omwe amatchulidwa ndi dzina loti genfarin, kapena warfarin, kapena Jantoven nthawi zina. Amagwiritsidwa ntchito popewa kupangika kwa magazi m'magazi monga atribrillation, stroke, infarction ya myocardial, ndi venous thromboembolism. Amapezeka ngati piritsi lokamwa pamiyeso yosiyanasiyana kuyambira 1mg mpaka 10mg pa piritsi. Ali ku Coumadin, odwala ayenera kupereka mayeso a prothrombin (PT) omwe amadziwika kuti ndi International Normalized Ratio (INR) kuti adziwe ngati mankhwala a wodwalayo ndi oyenera. Warfarin nthawi zambiri sagwiritsidwa ntchito kwa odwala ochepera miyezi inayi yakubadwa chifukwa cha zovuta zoyang'anira komanso kuthekera kwa zinthu zosadziwika zomwe zimakhudza kukhudzidwa.

Heparin ndi mankhwala akuchipatala omwe amagwiritsidwa ntchito kwambiri kwa odwala. Amagwiritsidwa ntchito popewa kupangika kwa magazi m'matumba monga deep venous thrombosis, pulmonary embolism, ndi atrial fibrillation. Amagwiritsidwanso ntchito popewa kutsekemera kwa magazi munjira zomwe zimakhudza mtima ndi mitsempha yamagazi. Heparin imapezeka m'njira zosiyanasiyana zothetsera jakisoni kapena infusions. Pali mtundu wina wa heparin womwe umapangidwira kokha kumitsempha yolumikizira mzere kuti iteteze mapangidwe am'magazi pamzere. Izi zimatchedwa heparin loko flush, ndipo kapangidwe kameneka sikuyenera kugwiritsidwa ntchito pazinthu zina zilizonse. Heparin itha kugwiritsidwa ntchito kwa odwala amisinkhu iliyonse, koma kuyang'anitsitsa kumafunikira.

Kusiyana kwakukulu pakati pa Coumadin ndi Heparin
	Coumadin	Heparin
Gulu la mankhwala osokoneza bongo	Wotsutsa	Wotsutsa
Chizindikiro cha Brand / generic	Zolemba ndi generic zilipo	Zolemba ndi generic zilipo
Kodi dzina lachibadwa ndi liti? Kodi dzina lake ndi ndani?	Warfarin Coumadin	Heparin
Kodi mankhwalawa amabwera mwa mawonekedwe ati?	Piritsi (mphamvu zingapo)	Njira yothetsera jakisoni kapena kulowetsedwa (magawo angapo amapezeka)
Kodi mulingo woyenera ndi uti?	Odwala ambiri amayamba pa 5 mg tsiku lililonse, koma mlingo wosamalira umadalira INR ya wodwala aliyense	Wodwala wamkulu wamkulu azilandira mlingo wokwanira wa mayunitsi 5,000 wotsatiridwa ndi mayunitsi 20,000 mpaka 30,000 kupitirira maola 24 pomulowetsa mosalekeza.
Kodi mankhwalawa amatenga nthawi yayitali bwanji?	Ochepera miyezi 3, koma atha kukhala osadziwika kutengera mawonekedwe	Nthawi zambiri masiku angapo, mpaka sabata
Ndani amagwiritsa ntchito mankhwalawa?	Akuluakulu	Akuluakulu

Zomwe amathandizidwa ndi Coumadin ndi heparin

Coumadin imagwiritsidwa ntchito popewa ndikuchiza venous thromboembolism ndi pulmonary embolism komanso zovuta zama coagulation zomwe zimakhudzana ndi atril fibrillation ndimakina m'malo mwa ma valve. Coumadin imagwiritsidwanso ntchito kupewetsa zovuta zokhudzana ndi kugundana zomwe zimatha kutsatira myocardial infarction kapena matenda amtima.

Heparin imagwiritsidwanso ntchito kupewetsa ndi kuchiza venous thromboembolism ndi pulmonary embolism komanso zovuta zamaganda zomwe zimakhudzana ndi atril fibrillation. Kuphatikiza apo, heparin imagwiritsidwa ntchito popewa kugundana kwamitsempha yama mtima, kuthira magazi, komanso njira za dialysis.

Mkhalidwe	Coumadin	Heparin
Venous thromboembolism	Inde	Inde
Kuphatikizika kwa pulmonary	Inde	Inde
Matenda a Atrial	Inde	Inde
Mitundu yamagetsi yamagetsi	Inde	Inde
Matenda a post-myocardial infarction omwe amabwera chifukwa chotseka	Inde	Ayi
Kuphatikizika kwamphamvu kwamatenda (angioplasty)	Ayi	Inde
Kuikidwa magazi	Ayi	Inde
Dialysis	Ayi	Inde

Kodi Coumadin kapena heparin ndiwothandiza kwambiri?

Coumadin ndi heparin ali ndi zosiyana zomwe zimawapatsa aliyense malo ofunikira, nthawi zambiri mwa wodwala yemweyo.

Kutha kwa theka la moyo ndi nthawi yofika pachimake pazinthu ziwiri zofunika kwambiri pakudziwa momwe mungagwiritsire ntchito mankhwala aliwonse. Coumadin imafika pachimake m'magazi a plasma kuchokera pa mlingo umodzi pafupifupi maola 4, ndikuchotsa theka la moyo pafupifupi maola 40. Chifukwa cha zinthu zingapo zomwe zimatha kusiyanasiyana ndi wodwala aliyense, zimatha kutenga masiku mpaka milungu kuti mufike ku INR yothandizira. Heparin imafika pachimake m'magazi a plasma mu 2 mpaka maola 4, ndikuchotsa theka la moyo pafupifupi mphindi 60-90.

Pulogalamu ya malangizo kuyang'anira mitsempha yakuya ya thrombosis (DVT) ndi kuphatikizika kwamapapu kwamitundu yambiri ya odwala kumalimbikitsa kugwiritsa ntchito heparin koyambirira chifukwa chakuyamba msanga kwake. Kuchita bwino kwachipatala kumatheka mwa kuperekera mulingo wotsitsa wotsatiridwa ndi muyeso wokonzanso. Izi zikupitilizidwa pomwe chithandizo cha Coumadin chimayambitsidwa, ndipo mpaka INR ya wodwalayo ikuthandizira. Izi zitha kutenga masiku 7-10. Heparin nthawi zambiri amafunika kuyang'aniridwa ndi odwala, koma wodwala amatha kupita kwawo akangosamukira ku Coumadin.

Ndi omwe amapereka chithandizo chamankhwala okha omwe angadziwe kuti ndi mankhwala ati, kapena kuphatikiza kwa mankhwala, omwe ndi oyenerera wodwala aliyense. Othandizira ayenera kuganizira zinthu zambiri zokhudzana ndi odwala, monga mbiri ya zochitika zotseka, zaka, chithandizo cham'mbuyomu, komanso mbiri yazomwe zimachitika chifukwa cha heparin-induced thrombocytopenia.

Kuphunzira ndi kuyerekezera mtengo wa Coumadin vs. heparin

Ma Medicare ambiri ndi mapulani a inshuwaransi yamalonda amatenga Coumadin, ndi / kapena mtundu wake wa warfarin. Mtengo wapakati wazogulitsa wa Coumadin ukhoza kuyambira $ 80 mpaka $ 120 dollars. Mutha kupeza warfarin pafupifupi $ 10 ndi coupon ya SingleCare.

Heparin nthawi zambiri amaperekedwa kuchipatala ndipo nthawi zambiri amaikapo Medicare Gawo B . Kwa odwala omwe si a Medicare, amathandizidwa ndi inshuwaransi ya zamankhwala akawona kuti ndi yofunikira komanso yofunikira. Kutuluka kwa wodwala kuthumba kumadalira pazinthu zingapo kuphatikiza ngati akwanitsa kuchotseredwa ndalama zawo komanso ngati ali ndi zowonjezera zowonjezera. Wodwala akapeza kuti Heparin yawo siiphimbidwa, amatha kutsitsa coupon ndikulipira $ 45 ngati mutalandira mankhwala.

	Coumadin	Heparin
Nthawi zambiri amakhala ndi inshuwaransi?	Inde	Inde
Nthawi zambiri amadzazidwa ndi Medicare?	Inde	Inde, Gawo B
Mlingo woyenera	30, 5 mg mlingo	25 ml, 5000 unit / ml
Wopanga Medicare wamba	Zimasintha	Zimasintha
Mtengo wosakwatiwa	$ 4- $ 14	$ 45- $ 65

Zotsatira zoyipa za Coumadin ndi heparin

Ambiri zotsatira zoyipa onse a Coumadin ndi heparin amataya magazi kapena amatuluka magazi kwambiri. Zizindikiro zina zotulutsa magazi zimatha kukhala zovuta kuzizindikira, koma zina mwazizindikiro zowonekera bwino ndikuphatikizira kuvulala kosavuta, kutulutsa magazi m'mphuno, kutuluka magazi m'kamwa, mkodzo wofiirira kapena wofiira, ndi magazi m'maso. Ngati wodwala atsimikiza kuti akukha magazi, kusiya mankhwalawa ndikofunikira, kaya kwakanthawi kapena kwakanthawi.

Heparin-induced thrombocytopenia (HIT) yadziwika ndi 1-2% ya odwala omwe amapatsidwa heparin. Kutsika kwakukulu kwa kuchuluka kwa ma platelet kumatha kubweretsa zovuta zazikulu monga necrosis ya minofu ndi chilonda.

Palinso zovuta zina ndi zovuta zoyipa zochokera kuchipatala ndi Coumadin kapena heparin. Dokotala kapena wamankhwala atha kupereka mndandanda wathunthu wazovuta.

	Coumadin	Heparin
Zotsatira zoyipa	Zoyenera?	Pafupipafupi	Zoyenera?	Pafupipafupi
Kutaya magazi	Inde	1-10%	Inde	1-10%
Chiwombankhanga / Khungu Necrosis	Inde	<1%	Inde	<1%
Thrombocytopenia	Ayi		Inde	≤30%
KUMENYA	Ayi		Inde	1-2%

Uwu sungakhale mndandanda wathunthu wazomwe zikuchitika. Chonde funsani dokotala kapena wamankhwala kuti mumve mndandanda wonse.
Gwero: DailyMed ( Coumadin ), Tsiku Lililonse ( mankhwala ).

Kuyanjana kwa mankhwala a Coumadin vs. heparin

Coumadin imagwiritsidwa ntchito ndi michere ya cytochrome P450, makamaka ma subtypes 2C9, 1A2, ndi 3A4. Zoletsa ma enzyme izi zimachulukitsa milingo ya Coumadin, chifukwa chake kukulitsa INR ya wodwala ndikuwonjezera chiopsezo chotaya magazi. Zitsanzo za ma enzyme inhibitors zimaphatikizapo ma antifungals monga fluconazole, ndi mankhwala odziwika bwino a cholesterol, atorvastatin. Othandizira ma enzyme amachepetsa milingo ya Coumadin, zomwe zingapangitse INR wodwalayo kulandira chithandizo ndikuwonjezera kuthamangitsidwa kwa zochitika za thrombotic. Zitsanzo za zopangira ma enzyme zimaphatikizapo mankhwala oletsa kulanda carbamazepine ndi phenobarbital.

Zotsatira za heparin zitha kutheka ndi mankhwala antiplatelet ngati ma NSAID. Ibuprofen angakhale chitsanzo. Zotsatira za heparin zitha kuchepetsedwa chifukwa chothandizidwa ndi maantibayotiki wamba monga doxycycline.

Gome lotsatirali si mndandanda wazinthu zonse zomwe zikuchitika. Wopereka chithandizo chazaumoyo wanu akhoza kukupatsani mndandanda wokwanira komanso zowonjezera pazomwe mungachite.

Mankhwala osokoneza bongo	Gulu la Mankhwala	Coumadin	Heparin
Amiodarone Zamgululi	Wosakanikirana	Inde	Ayi
Fluconazole Chinthaka Ketoconazole Miconazole Voriconazole	Anti-mafangasi	Inde	Ayi
Phenobarbital Carbamazepine	Wosakanikirana	Inde	Ayi
Cimetidine Chotchuka Ranitidine	Maantibayotiki	Inde	Ayi
Ciprofloxacin Mankhwala osakaniza	Mankhwala a Fluoroquinolone	Inde	Ayi
Clarithromycin Mankhwalawa Telithromycin	Macrolide Maantibayotiki	Inde	Ayi
Doxycycline Minocycline	Mankhwala a Tetracycline	Ayi	Inde
Atorvastatin Fluvastatin Simvastatin	HMG Co-A Reductase Inhibitors (Ma Statins)	Inde	Ayi
Kuphatikiza kwa Estrogen ndi Progestin	Njira zolerera pakamwa	Inde	Inde
Apixaban Rivaroxaban ufa Edoxaban	Magazi ocheperako	Ayi	Inde
Zamgululi Naproxen	NSAID	Inde	Inde
Alireza Meloxicam	Cox II Woletsa	Inde	Inde

Machenjezo a Coumadin ndi heparin

Coumadin ndi heparin atha kukulitsa zomwe zimayambitsa kukha magazi. Mankhwala ena amatha kuwonjezera mwayi woti izi zichitike. Odwala ku Coumadin ayenera kuyang'aniridwa ndi INR pafupipafupi. Kudya kwambiri vitamini K, komwe kumapezeka muzakudya zambiri monga masamba obiriwira, kumatha kuchepetsa mphamvu ya Coumadin. Odwala ayenera kudya Vitamini K tsiku lililonse ali ku Coumadin kuti akhale ndi INR yothandizira. Coumadin amatsutsana ndi mimba.

Heparin-induced thrombocytopenia imachitika mwa 1% mpaka 2% ya odwala ndipo ndichinthu choopsa chomwe chimabweretsa kuwonongeka kwa ma platelet. Izi zimatha kubweretsa zilonda zapakhosi ndi khungu ngati sizigwidwa munthawi yake.

Mafunso omwe amafunsidwa pafupipafupi za Coumadin vs. heparin

Coumadin ndi chiyani?

Coumadin ndi mankhwala anticoagulant am'kamwa omwe amagwiritsidwa ntchito pochiza ndi kupewetsa matenda a venous thrombosis ndi pulmonary embolism. Amagwiritsidwanso ntchito kuthana ndi zochitika zowumitsa zomwe zimakhudzana ndi atril fibrillation komanso kukhazikika kwamtima kwamtima. Amamwa pakamwa kamodzi patsiku, ndipo odwala amayenera kuyang'aniridwa ndi INR pafupipafupi kuti awonetsetse kuti kuchuluka kwawo kwa Coumadin ndikoyenera.

Kodi heparin ndi chiyani?

Heparin ndi mankhwala a anticoagulant omwe amaperekedwa kudzera m'mitsempha pachipatala. Amagwiritsidwa ntchito pochiza ndi kupewetsa matenda a venous thrombosis ndi embolism ya m'mapapo mwanga. Amagwiritsidwanso ntchito kuthana ndi zochitika zogwiritsa ntchito popanga opaleshoni yamtima ndi ya venous. Odwala nthawi zambiri amalandila mlingo wotsitsa womwe umatsatiridwa ndi kulowetsedwa, komwe kumatha masiku angapo kutengera chithandizo.

Kodi Coumadin ndi heparin ndi ofanana?

Ngakhale Coumadin ndi heparin onse ndi mankhwala a anticoagulant, siofanana. Coumadin ndi mankhwala am'kamwa omwe amagwiritsidwa ntchito kwambiri kuchipatala, pomwe heparin ndi mankhwala ojambulidwa omwe amagwiritsidwa ntchito mchipatala.

Kodi Coumadin kapena heparin ndibwino?

Kuyamba kwa Heparin ndichangu kwambiri kuposa Coumadin koma kuyenera kutsatiridwa ndi kulowetsedwa kosalekeza kapena jakisoni pafupipafupi. Chifukwa chake, heparin amatha kugwiritsidwa ntchito mchipatala. Coumadin imatha kutenga masiku angapo kuti ichite bwino koma ndiyabwino kuyitanira kuchipatala. Odwala ku Coumadin ayenera kuyezetsa magazi pafupipafupi kuti atsimikizire kuti INR yawo ili m'njira yoyenera.

Kodi nditha kugwiritsa ntchito Coumadin kapena heparin ndili ndi pakati?

Coumadin amadutsa m'mimba mwa amayi apakati ndipo zatsimikizika kuti zimakhudza thupi. Coumadin, ndiye kuti, amatsutsana ali ndi pakati pokhapokha ngati wodwalayo ali ndi valavu yamtima wamakina kapena ali pachiwopsezo chachikulu chochitika cha thromboembolic. Heparin imatha kuperekedwa panthawi yoyembekezera chifukwa siyidutsa m'mimba mwake, komabe, ambiri mwa akatswiri amakonda ma cell ochepa a heparin (LMWH) m'mimba ngati Lovenox (enoxaparin).

Kodi ndingagwiritse ntchito Coumadin kapena heparin ndi mowa?

Palibe zotsutsana ndi kumwa mowa kwa Coumadin kapena heparin. Komabe, mowa umatha kukhudza odwala ena, ndikupangitsa kufunikira koyang'anitsitsa INR mukamamwa Coumadin.