Qhov Tseem Ceeb Qhov txawv - Anticoagulants vs Thrombolytics
Anticoagulants yog cov tshuaj uas siv los tiv thaiv kev tsim cov ntshav txhaws hauv cov hlab ntsha hauv lub cev, qhov thrombolytics yog cov tshuaj siv rau kev tshem tawm cov thrombi uas ua rau cov hlab ntsha, ua rau ntau yam kab mob xws li ischemic plawv plawv thiab mob stroke.. Qhov sib txawv loj ntawm cov tshuaj tiv thaiv coagulants thiab thrombolytics yog cov tshuaj anticoagulants siv los tiv thaiv kev tsim cov ntshav txhaws tshiab hauv cov hlab ntsha, thaum thrombolytics yog siv los tshem tawm cov ntshav txhaws uas twb tau tsim hauv cov hlab ntsha.
Anticoagulants yog dab tsi?
Cov ntshav txhaws yog ib qho mesh ua haujlwm ntawm fibrin fibers khiav hauv txhua qhov kev qhia thiab nkag mus rau cov qe ntshav, platelets thiab plasma. Clotting yog ib qho kev ua haujlwm ntawm lub cev uas tau pib los teb rau kev tawg ntawm cov hlab ntsha lossis kev puas tsuaj rau cov ntshav nws tus kheej. Cov stimuli no ua rau cov tshuaj tua kab mob los tsim cov tshuaj hu ua prothrombin activator. Prothrombin activator ces catalyzes hloov ntawm prothrombin rau thrombin. Thaum kawg, thrombin, uas ua raws li ib qho enzyme, catalyzes tsim cov fibrin fibers los ntawm fibrinogen thiab cov fibrin fibers entangle nrog ib leeg ua ib tug fibrin mesh uas peb hu ua clot.
Raws li tau hais dhau los, kev ua kom lub cev ntawm cov tshuaj yog xav tau rau kev tsim cov prothrombin activator. Qhov tshwj xeeb ua kom cov tshuaj no tuaj yeem tshwm sim ntawm ob txoj hauv kev loj.
- Txoj hauv kev nkag siab - nws yog txoj hauv kev nkag mus uas tau qhib thaum muaj ntshav raug mob
- Txoj kev Extrinsic - txoj kev tawm sab nraud tau qhib thaum lub phab ntsa vascular raug mob lossis cov ntaub so ntswg los ntawm cov ntshav.
Tib neeg lub vascular system siv ntau lub tswv yim txhawm rau tiv thaiv kev tsim cov ntshav txhaws hauv cov hlab ntsha hauv qhov qub.
- Endothelial Surface Factors - Qhov smoothness ntawm qhov chaw endothelial pab tiv thaiv kev sib cuag ntawm txoj hauv kev. Muaj lub tsho tiv no ntawm glycocalyx ntawm endothelium uas ua rau cov ntshav txhaws thiab platelets, yog li tiv thaiv kev tsim cov ntshav txhaws. Muaj cov thrombomodulin, uas yog ib qho tshuaj muaj nyob rau ntawm endothelium pab tiv thaiv cov txheej txheem ntawm cov ntshav txhaws. Thrombomodulin khi nrog thrombin thiab nres kev ua haujlwm ntawm fibrinogen.
- Cov tshuaj tiv thaiv thrombin ntawm fibrin thiab antithrombin iii.
- Kev ua ntawm heparin
- Lysis ntawm cov ntshav txhaws los ntawm plasminogen
Nws yog pov thawj los ntawm cov kev ntsuas no uas tib neeg lub cev tsis xav kom muaj cov ntshav txhaws hauv nws raws li cov xwm txheej ib txwm muaj. Tab sis evading cov txheej txheem tiv thaiv cov ntshav txhaws tuaj yeem tsim hauv peb lub cev. Cov xwm txheej zoo li kev raug mob, atherosclerosis, thiab kev kis kab mob tuaj yeem ua rau lub ntsej muag endothelial, ua kom txoj hauv kev txhaws. Txhua yam pathology uas ua rau cov hlab ntsha nqaim kuj muaj qhov ua rau cov hlab ntsha vim qhov nqaim ntawm cov hlab ntsha ua rau cov ntshav ntws los ntawm nws thiab yog li ntawd ntau procoagulants tau sau nyob rau ntawm qhov chaw ua kom muaj qhov chaw zoo rau kev tsim cov ntshav txhaws..
YBasic Pharmacology ntawm Anticoagulants
Anticoagulants yog cov tshuaj uas siv los tiv thaiv kev tsim cov ntshav txhaws hauv cov hlab ntshav. Raws li cov txheej txheem ntawm kev ua ntawm cov tshuaj no, lawv tau categorized rau hauv subcategories sib txawv.
Indirect Thrombin Inhibitors
Cov tshuaj no hu ua indirect thrombin inhibitors vim tias lawv inhibition ntawm thrombin tshwm sim los ntawm kev cuam tshuam nrog lwm cov protein hu ua antithrombin. Unfractionated heparin (UFH) thiab Tsawg Molecular Nyhav Heparin (LMWH) khi rau antithrombin txhim kho nws qhov tsis ua haujlwm ntawm yam Xa.
Heparin
Antithrombin inhibits qhov kev txiav txim ntawm cov ntshav txhaws IIa, IXa, thiab Xa los ntawm kev tsim cov complexes ruaj khov nrog lawv. Thaum tsis muaj heparin, cov tshuaj tiv thaiv no tshwm sim maj mam. Heparin ua raws li cofactor rau anti-thrombin nce tus nqi ntawm cov kev cuam tshuam cuam tshuam los ntawm tsawg kawg yog 1000 folds. Unfractioned heparin markedly inhibits ntshav txhaws los ntawm inhibiting tag nrho peb yam xws li thrombin thiab factor Xa. Tab sis cov nyhuv anticoagulant ntawm qis molecular hnyav heparin yog tsawg dua li ntawm UFH vim nws tsis tshua muaj affinity ntawm antithrombin. Enoxaparin, d alteparin, thiab tinzaparin yog qee qhov piv txwv rau LMWH.
Kev saib xyuas cov ntshav txhaws cov txheej txheem ntawm cov neeg mob tau txais UFH yog qhov tseem ceeb heev. Qhov no yog ua los ntawm kev ntsuas APTT ntawm tus neeg mob feem ntau nyob rau ib hlis. Ntawm qhov tod tes, kev soj ntsuam zoo li no tsis tas yuav tsum muaj rau cov neeg mob uas nyob hauv LMWH vim tias nws cov tshuaj pharmacokinetics thiab qib ntshav plasma.
Txoj Kev Nyuaj Siab
- xiav los ntshav tom qab txawm tias mob me me
- Heparin-induced thrombocytopenia
YContraindications
- Hypersensitivity rau tshuaj
- Tshuaj ntshav
- intracranial hemorrhages
- mob siab heev
- Active TB
- Thrombocytopenia tseem ceeb
- Tshuaj abortion
Cov nyhuv anticoagulant ntau dhau ntawm heparin tuaj yeem kho tau los ntawm kev txiav cov tshuaj. Yog hais tias los ntshav tsis tu, kev tswj hwm ntawm protamine sulfate yog qhia.
YWarfarin
Warfarin yog ib qho tshuaj tiv thaiv kab mob uas nquag siv nrog 100% ntawm bioavailability. Feem ntau ntawm cov tshuaj warfarin muab rau hauv tib neeg lub cev yog khi rau plasma albumin muab nws qhov ntim me me ntawm kev faib tawm thiab ntev ib nrab-lub neej.
Warfarin tiv thaiv cov carboxylation ntawm glutamate residues ntawm prothrombin, clotting yam VII, IX thiab X. Qhov no ua rau cov molecules inactive impairing lub txheej txheem ntawm clotting. Muaj 8- 12 teev qeeb hauv qhov kev txiav txim ntawm warfarin vim muaj cov carboxylated molecules ntawm cov cofactors yav dhau los uas nws qhov kev txiav txim npog cov nyhuv ntawm warfarin.
Daim duab 01: Warfarin
Txoj Kev Nyuaj Siab
- Warfarin tuaj yeem dhau los ntawm qhov chaw pov tseg uas ua rau muaj mob hemorrhagic hauv tus menyuam hauv plab
- Nws tseem tuaj yeem ua rau pob txha deformations hauv fetus.
Lwm yam tshaj li cov tshuaj tiv thaiv kab mob uas nquag siv, qhov ncauj ncaj qha Xa inhibitors xws li rivaroxaban thiab niam txiv ncaj qha thrombin inhibitors kuj tau siv los tswj coagulation.
Thrombolytics yog dab tsi?
Thrombolytics yog cov tshuaj siv rau kev tshem tawm cov thrombi uas ua rau cov hlab ntsha ua rau ntau yam kab mob xws li mob plawv ischemic thiab mob stroke.
Kev siv thaum ntxov ntawm thrombolytics hauv kev tswj cov kab mob plawv ischemic tau ua pov thawj tias muaj txiaj ntsig zoo hauv kev txo qhov loj ntawm cov thrombus thiab nce patency ntawm lub nkoj.
Txhua tus neeg ua haujlwm thrombolytic ua los ntawm kev ua kom plasminogen rau plasmin uas ua rau cov fibrin degradation ob qho tib si hauv thrombi thiab hauv cov hemostatic fibrin plugs. Qhov no ua rau muaj kev pheej hmoo ntawm intracranial hemorrhages.
YStreptokinase
Streptokinase yog ib qho enzyme tsim los ntawm beta-hemolytic streptococci. Nws tsim ib tug complex nrog plasminogen thiab ces cleaves plasminogen rau hauv plasmin. Txij li thaum streptokinase yog ib yam khoom txawv teb chaws rau lub cev, qee cov neeg mob tuaj yeem tsim kev tsis haum rau nws. Xws li cov neeg mob uas xav tau thrombolysis vim muaj ntau yam kab mob thiab hypersensitive rau streptokinase yuav tsum nqa daim ntawv tshuaj kom meej meej qhia lawv txoj kev xav tsim kev tsis haum rau streptokinase.
Alteplase
Recombinant alteplase yog tsim los ntawm endogenous fibrinolytic enzyme uas nws tso tawm ua rau fibrinolysis. Txawm hais tias alteplase muaj cov nyhuv thrombolytic sai dua li streptokinase, nws muaj kev pheej hmoo siab ua rau intracranial hemorrhages. Ntawm qhov tod tes, cov tshuaj no kim dua li lwm cov tshuaj thrombolytic.
Dab tsi yog qhov zoo sib xws ntawm Anticoagulants thiab Thrombolytics?
Ob pawg tshuaj yog siv los tswj cov coagulation
Qhov txawv ntawm Anticoagulants thiab Thrombolytics yog dab tsi?
Anticoagulants vs Thrombolytics |
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| Anticoagulants yog cov tshuaj uas siv los tiv thaiv kev tsim cov ntshav txhaws hauv cov hlab ntshav. | Thrombolytics yog cov tshuaj siv rau kev tshem tawm cov thrombi, uas ua rau cov hlab ntsha thiab ua rau ntau yam kab mob xws li mob plawv ischemic thiab mob stroke. |
| Cov no yog siv los tiv thaiv kev tsim cov ntshav txhaws hauv cov hlab ntsha. | Cov no yog siv los tshem tawm cov ntshav txhaws uas twb tau tsim hauv cov hlab ntsha. |
| Action | |
| Lawv ua los ntawm inactivating ntau yam khoom ntawm lub cotting cascade. | Txhua tus neeg ua haujlwm thrombolytic ua los ntawm kev ua kom plasminogen rau plasmin uas ua rau kev degradation ntawm fibrin ob qho tib si hauv thrombi thiab hauv cov hemostatic fibrin plugs. |
| Txoj kev phem | |
|
Cov teebmeem ntawm heparin
Cov teebmeem tsis zoo ntawm warfarin
|
Yuav muaj kev tsis haum tshuaj tiv thaiv kab mob streptokinase. Intracranial hemorrhages yog qhov ua rau tuag taus ntawm thrombolytics. |
| contraindications | |
|
Contraindications rau heparin yog,
|
Kev siv streptokinase yog contraindicated yog tias tus neeg mob tsis haum rau nws. |
Summary – Anticoagulants vs Thrombolytics
Anticoagulants yog cov tshuaj uas siv los tiv thaiv kev tsim cov ntshav txhaws hauv cov hlab ntsha. Thrombolytics yog cov tshuaj siv rau kev tshem tawm cov thrombi uas ua rau cov hlab ntsha ua rau ntau yam kab mob xws li mob plawv ischemic thiab mob stroke. Thaum cov tshuaj tiv thaiv coagulants tau siv los tiv thaiv kev tsim cov ntshav txhaws, thrombolytics yog siv los tshem tawm cov ntshav txhaws uas twb tau tsim nyob rau hauv cov hlab ntsha occluding lawv. Qhov no yog qhov sib txawv loj ntawm ob pawg tshuaj no.
Download PDF Version of Anticoagulants vs Thrombolytics
Koj tuaj yeem rub tawm PDF version ntawm kab lus no thiab siv nws rau offline hom phiaj raws li cov ntawv sau tseg. Thov download PDF version ntawm no Qhov txawv Ntawm Thrombolytics thiab Anticoagulants
