Main >> Izidakamizwa Vs. Umngani >> ICoumadin vs. heparin: Umehluko, ukufana, nokuthi yikuphi okungcono kuwe

ICoumadin vs. heparin: Umehluko, ukufana, nokuthi yikuphi okungcono kuwe

Izidakamizwa Vs. Umngani

Ukwelashwa kwe-Anticoagulation kudlala indima enkulu ekuphathweni kwezimo ezinzima ezifana ne-atrial fibrillation, venous thromboembolism, kanye nokubekwa kwe-valve yenhliziyo ngomshini. Imithi elwa namagciwane i-Coumadin ne-heparin isiza ukuphatha nokuvimbela ukwakheka kwamahlule egazi angabulala kulezi zimo.

UVitamin K uyinto esemqoka endleleni eya ekwakhekeni kwamahlwili. Kuyadingeka ekuhlanganisweni kwezinto zokuvala ezisebenzayo II, VII, IX, kanye no-X. Uma isetshenziswa ekuhlanganisweni kwalezi zinto zokuvala igazi, uvithamini K uyavalwa futhi kufanele uvuselelwe i-vitamin K epoxide reductase complex 1 (VKORC1) ukuze uqhubeke nokubamba iqhaza kunqubo yokwakhiwa kwamagundane. I-Coumadin ivimbela ingxenye yenkimbinkimbi ye-VKOR futhi ngaleyo ndlela ifaka isandla ekunciphiseni uvithamini K emzimbeni, okwehlisa ikhono lomzimba lokwenza amahlule.

IHeparin isebenza ngokuzibophezela kwiprotheni antithrombin III ebuye isebenzise i-thrombin nezinye izinto ezijiyisayo, okubaluleke kakhulu i-Xa. Lezi zinyathelo zivimbela ukuguqulwa kwe-fibrinogen ibe yi-fibrin, okuyisinyathelo esiyinhloko ekwakheni ama-clot. Ngokunciphisa ukwakheka kwe-fibrin, i-heparin inciphisa ukwakheka kwamahlwili emzimbeni.

Uyini umehluko omkhulu phakathi kweCoumadin ne-heparin?

I-Coumadin ngumuthi kadokotela ovame ukubizwa ngegama lawo elejwayelekile, i-warfarin, noma kwesinye isikhathi iJantoven. Isetshenziselwa ukuvimbela ukwakheka kwamahlule egazini ezimeni ezifana ne-atrial fibrillation, stroke, infarction ye-myocardial, ne-venous thromboembolism. Iyatholakala njengethebhulethi yomlomo ezinhlosweni ezahlukahlukene ezisukela ku-1mg kuye ku-10mg ithebhulethi ngayinye. Ngesikhathi ziseCoumadin, iziguli kufanele zithumele ekuhlolweni okuvamile kwe-prothrombin (PT) okubikwe njenge-International Normalized Ratio (INR) ukunquma ukuthi ingabe umthamo wesiguli ufanelekile ngokwelashwa yini. I-Warfarin imvamisa ayisetshenziswa ezigulini ezingaphansi kwezinyanga ezine ubudala ngenxa yezinkinga zokuphatha kanye namandla wezici zofuzo ezingatholakali ezingathinta ukuzwela.

I-Heparin ngumuthi kadokotela ovame ukusetshenziswa kakhulu kulungiselelwa iziguli. Isetshenziselwa ukuvimbela ukwakheka kwamahlule egazini ezimeni ezinjenge-venous thrombosis, embolism pulmonary, kanye ne-atrial fibrillation. Ibuye isetshenziselwe ukuvimbela ukwakheka kwamahlwili ngesikhathi sezinqubo ezibandakanya inhliziyo nemithambo yegazi. I-heparin itholakala ngezindlela ezahlukahlukene zezixazululo zemijovo efakwa emithanjeni noma emithanjeni. Kukhona ukwakheka okuthile kwe-heparin okuhloselwe kuphela ukugeleza ngomugqa ngemithambo ukuvimbela ukwakheka kwamahlwili kulayini. Lokhu kubizwa ngokuthi yi-heparin lock flush, futhi lokhu kwakhiwa akufanele kusetshenziselwe enye injongo. I-Heparin ingasetshenziselwa iziguli zanoma yimuphi ubudala, kepha ukuqapha okusondele kuyadingeka.

Umehluko omkhulu phakathi kweCoumadin neHeparin
	I-Coumadin	I-Heparin
Isigaba sezidakamizwa	I-Anticoagulant	I-Anticoagulant
Isimo somkhiqizo / ejwayelekile	I-Brand ne-generic iyatholakala	I-Brand ne-generic iyatholakala
Ngubani igama elijwayelekile? Ngubani igama lomkhiqizo?	I-Warfarin I-Coumadin	I-Heparin
Izidakamizwa zingena ngaziphi izinhlobo?	Ithebhulethi (amandla amaningi)	Isixazululo somjovo noma ukumnika (ukugxila okuningi kuyatholakala)
Uyini umthamo ojwayelekile?	Iziguli eziningi ziqala ku-5 mg nsuku zonke, kepha umthamo wesondlo uncike ku-INR yesiguli ngasinye	Isiguli esikhulile esizokwelashwa sizothola umthamo wokulayisha wamayunithi angama-5 000 alandelwe amayunithi angama-20 000 kuye kwangama-30,000 ngaphezulu kwamahora angama-24 ekufakweni okuqhubekayo.
Yelashwa isikhathi esingakanani?	Ubuncane bezinyanga ezi-3, kepha kungenzeka bube bungenamkhawulo ngokuya ngenkomba	Imvamisa izinsuku ezimbalwa, kuze kube yisonto
Ubani ovame ukusebenzisa umuthi?	Abantu abadala	Abantu abadala

Izimo eziphathwe yiCoumadin ne-heparin

I-Coumadin isetshenziselwa ukuvimbela nokwelapha i-venous thromboembolism kanye ne-pulmonary embolism kanye nezinkinga ze-coagulation ezihambisana ne-atrial fibrillation kanye ne-mechanical valve replacement. I-Coumadin nayo isetshenziselwa ukuvimbela izinkinga ezihlobene ne-coagulation ezingalandela i-infarction ye-myocardial noma isifo senhliziyo.

IHeparin nayo isetshenziselwa ukuvimbela nokwelapha i-venous thromboembolism kanye ne-pulmonary embolism kanye nezinkinga ze-coagulation ezihambisana ne-atrial fibrillation. Ngaphezu kwalokho, i-heparin isetshenziselwa ukuvimbela i-coagulation ekuhlinzekeni kwenhliziyo, ukumpontshelwa igazi, kanye nezinqubo ze-dialysis.

Isimo	I-Coumadin	I-Heparin
I-venous thromboembolism	Yebo	Yebo
I-embolism yamaphaphu	Yebo	Yebo
I-Atrial fibrillation	Yebo	Yebo
Ukushintshwa kwe-valve yemishini	Yebo	Yebo
Izinkinga ze-post-myocardial infarction ezihambisana nokuqina	Yebo	Akunjalo
Ukungenelela kwe-coronary okwenzeka ngamandla (angioplasty)	Akunjalo	Yebo
Ukumpontshelwa igazi	Akunjalo	Yebo
I-Dialysis	Akunjalo	Yebo

Ngabe iCoumadin noma i-heparin isebenza kangcono?

I-Coumadin ne-heparin zinokungafani okunika ngamunye indawo ebalulekile ekwelashweni, imvamisa esigulini esifanayo.

Isikhathi sokuphila sokuqeda nesikhathi sokugxila kakhulu yizinto ezimbili ezibaluleke kakhulu emtholampilo ekunqumeni ukuthi umuthi ngamunye uzowusebenzisa nini futhi nini. I-Coumadin ifinyelela amazinga aphezulu e-plasma kusuka kumthamo owodwa cishe emahoreni ama-4, ngokuqedwa kwengxenye yempilo cishe yamahora angama-40. Ngenxa yezici eziningana ezingahluka ngesiguli ngasinye, kungathatha izinsuku kuya emasontweni ukufinyelela ku-INR yezokwelapha. IHeparin ifinyelela ukugxila okuphezulu kwe-plasma emahoreni amabili kuya kwangu-4, ngokuqedwa kwempilo engaba yimizuzu engama-60-90.

I- imihlahlandlela Ukuphathwa kwe-vein thrombosis ejulile (i-DVT) kanye ne-pulmonary embolism yezinhlobo eziningi zeziguli kuzoncoma ukusetshenziswa kokuqala kwe-heparin ngenxa yokuqala kwayo ngokushesha. Ukusebenza kokwelapha kutholakala ngokuphatha umthamo wokulayisha olandelwa ngumthamo wesondlo. Lokhu kuyaqhubeka ngenkathi kuqala ukwelashwa kweCoumadin, futhi kuze kube yilapho i-INR yesiguli iselapha. Lokhu kungathatha izinsuku eziyi-7-10. I-Heparin ngokuvamile idinga ukuphathwa esimweni sokugula, kepha isiguli singaya ekhaya uma sesishintshelwe eCoumadin.

Umhlinzeki wezokunakekelwa kwempilo kuphela onganquma ukuthi yiluphi ukwelashwa, noma inhlanganisela yokwelashwa, efanele isiguli ngasinye. Abahlinzeki kufanele bacabangele izinto eziningi eziqondene nesineke, njengomlando wokuqothula imicimbi, ubudala, ukwelashwa kwangaphambilini, kanye nomlando wezimo ezifana ne-heparin-induced thrombocytopenia.

Ukuqhathaniswa kanye nezindleko zokuqhathaniswa kweCoumadin vs. heparin

Iningi lama-Medicare nezinhlelo zomshuwalense wezohwebo zimboza iCoumadin, kanye / noma uhlobo lwayo olujwayelekile lwe-warfarin. Izindleko ezijwayelekile zokuthengisa zeCoumadin zingaba kusuka ku- $ 80 kuye ku- $ 120 dollars. Ungathola i-warfarin cishe ngama- $ 10 ngekhuphoni le-SingleCare.

I-Heparin ivame ukunikezwa esimweni sesibhedlela futhi imbozwe ngaphansi Ingxenye yeMedare B . Ezigulini ezingezona ezeMedicare, zimbozwa ngumshuwalense wezokwelapha lapho ubhekwa njengonengqondo futhi odingekayo. Izindleko eziphuma ephaketheni lesiguli zizoxhomeka ezicini eziningana kufaka phakathi ukuthi ngabe bahlangabezane nemali ebanjwayo futhi uma benokufakwa okungeziwe. Uma isiguli sithola ukuthi i-Heparin yabo ayimboziwe, bangalanda isigqebhezana bese bakhokha imali ephansi njengama- $ 45 ukuthola incwadi kadokotela.

	I-Coumadin	I-Heparin
Ngokuvamile embozwe umshwalense?	Yebo	Yebo
Imbozwe ngokujwayelekile yi-Medicare?	Yebo	Yebo, Ingxenye B
Umthamo ojwayelekile	30, 5 mg umthamo	25 ml, 5000 unit / ml
I-Medicare copay ejwayelekile	Iyahlukahluka	Iyahlukahluka
Izindleko ze-SingleCare	$ 4- $ 14	$ 45- $ 65

Imiphumela emibi ejwayelekile yeCoumadin ne-heparin

Okuvame kakhulu okuqhamuka uma udla imishanguzo Kokubili i-Coumadin ne-heparin ukopha noma ukopha kakhulu. Ezinye izimpawu zokopha kungaba nzima ukuzibona, kepha ezinye zezimpawu ezisobala kakhulu zifaka ukulimazeka okulula, ukuphuma kwamakhala, ukopha ezinsinini, umchamo onsundu noma onombala wokugqwala negazi esweni. Uma isiguli sinqume ukopha, ukuhoxiswa komuthi kuyadingeka, noma ngabe kungokwesikhashana noma isikhathi eside.

I-heparin-induced thrombocytopenia (HIT) ibikwe ku-1-2% weziguli ezinikezwe i-heparin. Ukwehla okunzima kokubalwa kweplatelet kungaholela ezinkingeni ezinkulu ezifana ne-tissue necrosis ne-gangrene.

Kunezinye izinkinga nemiphumela emibi evela ekwelashweni nge-Coumadin noma i-heparin. Udokotela noma usokhemisi anganikeza uhlu oluphelele lwemiphumela emibi.

	I-Coumadin	I-Heparin
Imiphumela emibi	Kusebenza?	Imvamisa	Kusebenza?	Imvamisa
Ukopha	Yebo	1-10%	Yebo	1-10%
I-Gangrene / Isikhumba se-Necrosis	Yebo	<1%	Yebo	<1%
I-Thrombocytopenia	Akunjalo		Yebo	≤30%
HIT	Akunjalo		Yebo	1-2%

Lokhu kungenzeka kungabi uhlu oluphelele lwezehlakalo ezimbi. Sicela uxhumane nodokotela noma usokhemisi ukuthola uhlu oluphelele.
Umthombo: DailyMed ( I-Coumadin ), IDailyMed ( i-heparin ).

Ukusebenzisana kwezidakamizwa kweCoumadin vs. heparin

I-Coumadin ihlanganiswa nama-enzyme e-cytochrome P450, ikakhulukazi ama-subtypes 2C9, 1A2, ne-3A4. Ama-inhibitors ala ma-enzyme akhulisa amazinga e-Coumadin, ngakho-ke akhuphula i-INR yesiguli futhi andise nengozi yokopha. Izibonelo zalawa ma-enzyme inhibitors afaka ama-antifungal anjenge-fluconazole, kanye nomuthi odumile we-cholesterol, i-atorvastatin. Abenzi be-enzyme bazokwehlisa amazinga e-Coumadin, okungenza ukuthi i-INR yesiguli isetshenziselwe ukwelashwa futhi kwandise ukuxoshwa komcimbi we-thrombotic. Izibonelo ze-inducers inducers zifaka imishanguzo yokulwa nokubanjwa i-carbamazepine ne-phenobarbital.

Imiphumela ye-heparin ingabangelwa yimithi elwa namagciwane efana nama-NSAID. Ibuprofen kungaba isibonelo. Imiphumela yeHeparin ingancipha ngokusebenzisana nama-antibiotic ajwayelekile njenge-doxycycline.

Ithebula elilandelayo alulona uhlu olubandakanya konke lokusebenzisana. Umhlinzeki wakho wezokunakekelwa kwempilo anganikeza ngohlu oluphelele nemininingwane eyengeziwe ekusebenzisaneni ngakunye.

Izidakamizwa	Isigaba Sezidakamizwa	I-Coumadin	I-Heparin
Amiodarone I-Propafenone	I-antiarrhythmic	Yebo	Akunjalo
I-Fluconazole I-Itraconazole Ketoconazole Miconazole Voriconazole	I-Anti-fungal	Yebo	Akunjalo
I-Phenobarbital I-Carbamazepine	I-Anticonvulsant	Yebo	Akunjalo
I-Cimetidine I-Famotidine I-Ranitidine	Ama-Antacids	Yebo	Akunjalo
I-Ciprofloxacin I-Norfloxacin	Ama-antibiotic e-Fluoroquinolone	Yebo	Akunjalo
I-Clarithromycin I-Erythromycin I-Telithromycin	Macrolide Antibiotics	Yebo	Akunjalo
I-Doxycycline I-Minocycline	Ama-Antibiotic eTetracycline	Akunjalo	Yebo
I-Atorvastatin I-Fluvastatin Simvastatin	I-HMG Co-A Reductase Inhibitors (Izitatimende)	Yebo	Akunjalo
Inhlanganisela ye-Estrogen ne-Progestin	Izindlela zokuvimbela inzalo ngomlomo	Yebo	Yebo
I-Apixaban I-Rivaroxaban powder I-Edoxaban	Ukuncipha kwegazi	Akunjalo	Yebo
Ibuprofen I-Naproxen	I-NSAID	Yebo	Yebo
UCelecoxib UMeloxicam	I-Cox II Inhibitor	Yebo	Yebo

Izexwayiso zeCoumadin ne-heparin

I-Coumadin ne-heparin zingakhuphula ngamunye ukuvela komcimbi wokopha. Izidakamizwa ezithile zingakhuphula amathuba okuvela kwalokhu. Iziguli eziseCoumadin kumele zihlolwe njalo nge-INR yazo. Ukudla okuphezulu kukavithamini K, okuqukethwe ekudleni okuningi okufana nemifino eluhlaza, kunganciphisa ukusebenza kweCoumadin. Iziguli kufanele zigcine ukudla okungaguquguquki kwansuku zonke kukaVitamin K ngenkathi kuseCoumadin ukuze kugcinwe i-INR yokwelapha. I-Coumadin iphikisana nokukhulelwa.

I-thrombocytopenia eyenziwe ngeHeparin ivela ku-1% kuya ku-2% weziguli futhi ingumcimbi obucayi oholela ekubhujisweni kwama-platelet. Lokhu kungaholela ekuqobekeni kwesikhumba nokubola kwesikhumba uma kungabanjwa ngesikhathi.

Imibuzo ebuzwa njalo ngeCoumadin vs. heparin

Kuyini iCoumadin?

I-Coumadin yisidakamizwa somlomo sokulwa ne-anticoagulant esisetshenziselwa ukwelashwa kanye ne-prophylaxis ye-venous thrombosis kanye ne-pulmonary embolism. Ibuye isetshenziselwe ukuphatha imicimbi yokuvala amandla ehlotshaniswa ne-atrial fibrillation kanye nokubekwa kwe-stent yenhliziyo. Kuthathwa ngomlomo ngokuvamile kanye ngosuku, futhi iziguli kufanele zihlolwe njalo i-INR ukuqinisekisa ukuthi umthamo wazo weCoumadin ufanelekile.

Yini i-heparin?

I-Heparin yisidakamizwa se-anticoagulant esinikezwa ngemithambo yegazi endaweni yokubeka esibhedlela. Isetshenziselwa ukwelashwa kanye ne-prophylaxis ye-venous thrombosis kanye ne-pulmonary embolism. Ibuye isetshenziselwe ukuphatha imicimbi yokujiya kwegazi ngesikhathi senqubo yokuhlinzwa kwenhliziyo nemithambo yegazi. Iziguli ngokuvamile zithola umthamo wokulayisha olandelwa ukumnika, okungahlala izinsuku ezimbalwa ngokuya ngempatho.

Ngabe i-Coumadin ne-heparin ziyefana?

Ngenkathi iCoumadin ne-heparin kuyimithi yokwelapha i-anticoagulant, ayifani. I-Coumadin yisidakamizwa esidluliselwa ngomlomo esisetshenziswa kakhulu kulungiselelwa iziguli, kuyilapho i-heparin iyisidakamizwa esingajova esivame ukusetshenziswa esimweni sasesibhedlela.

Ngabe iCoumadin noma i-heparin ingcono?

Ukuqala kwesenzo kukaHeparin kushesha kakhulu kuneCoumadin kodwa kufanele kulandelwe ukumnika okuqhubekayo noma imijovo ejwayelekile. Ngakho-ke, i-heparin ingasetshenziswa kuphela esimeni sesibhedlela. I-Coumadin ingathatha izinsuku ezimbalwa ukuthi iphumelele kepha iphephile ukuthi ingathathwa kulungiselelwa abagulayo. Iziguli eziseCoumadin kufanele zihlolwe njalo ngegazi ukuqinisekisa ukuthi i-INR yazo ikububanzi obufanele.

Ngingayisebenzisa iCoumadin noma i-heparin ngenkathi ngikhulelwe?

I-Coumadin yeqa i-placenta kwabesifazane abakhulelwe futhi kufakazelwe ukuthi inemiphumela ye-teratogenic. I-Coumadin, ngakho-ke, iyaphikiswa ekukhulelweni ngaphandle kokuthi isiguli sine-valve yenhliziyo yomshini noma sisengozini enkulu kakhulu yomcimbi we-thromboembolic. I-Heparin inganikezwa ngesikhathi sokukhulelwa njengoba ingaweli i-placenta, noma kunjalo, odokotela abaningi bakhetha i-heparin yesisindo esiphansi (LMWH) ekukhulelweni okufana neLovenox (enoxaparin).

Ngingayisebenzisa iCoumadin noma i-heparin ngotshwala?

Akukho ukuphikisana nokusetshenziswa kotshwala kweCoumadin noma i-heparin. Kodwa-ke, utshwala bungathinta ukusebenza kwe-hepatic kwezinye iziguli, kudale isidingo sokuqapha okusondele kwe-INR lapho ithatha iCoumadin.