Cov tshuaj Fraxiparin: tso cov ntaub ntawv thiab cov nqi

Kev piav qhia cuam tshuam rau 29.12.2014

Lub npe Latin: Fraxiparine
ATX Code: B01AB06
Yam tshuaj muaj sia: Calcium Nadroparin (Nadroparin calcium)
Chaw tsim tshuaj paus: GLAXO CUA TXIAS NTAU LAWM (Fabkis)

1 koob txhaj tshuaj Fraxiparin yuav muaj 9500, 7600, 5700, 3800 lossis 2850 IU tiv thaiv Xa nadroparin calcium.

Cov khoom siv ntxiv: hydrochloric acid lossis cov tshuajcalcium hydroxidedej.

Pharmacodynamics thiab pharmacokinetics

Cov Tshuaj Hauv Tshuaj

Tsawg phaus molecularheparinkev tsim los ntawm depolymerization los ntawm heparin glycosaminoglycan nrog qhov nruab nrab molecular hnyav ntawm 4300 daltons.

Muaj tropism siab rau cov ntshav protein antithrombin 3, uas ua rau kev tawm tsam ntawm qhov xa Xa - qhov no feem ntau vim yog cov lus hais antithrombotic nyhuv nadroparin.

Kev ua kom zoo: cov nqaij mos tau hloov pauv blocker, fibrinolysis los ntawm kev tso ncaj qha ntawm cov nqaij mos plasminogenlos ntawm cov ntaub so ntswg endothelial, kev hloov pauv rheological ntawm cov ntshav (txo qis viscosity ntshav thiab nce ntxiv ntawm permeability ntawm daim nyias nyias ntawm platelet hlwb thiab granulocyte hlwb).

Piv rau nthuav tawm heparin muaj qhov ua kom tsis muaj zog ntawm cov haujlwm platelet, ntawm kev sib sau ua ke thiab ntawm thawj cov pob zeb hemostasis.

Thaum lub sijhawm ua haujlwm ntawm kev kho mob nrog kev ua haujlwm siab tshaj plaws, APTT elongation ntawm 1.4 zaug uas ntawm tus qauv yog ua tau. Hauv kev txhaj tshuaj prophylactic, nws tsis ua rau muaj zog txo hauv APTT.

Cov Tshuaj Pharmacokinetics

Tom qab txhaj tshuaj subcutaneous, qhov siab tshaj plaws los tiv thaiv Xa-kev ua haujlwm, uas yog, qhov siab tshaj plaws nyob rau hauv cov ntshav tau mus txog tom qab 4-5 teev, yuav luag tag nrho nqus (nce txog 88%). Nrog kev txhaj tshuaj rau siab, qhov siab tshaj plaws hauv kev tiv thaiv Xa-tshwm sim tom qab 10 feeb. Kev tshem tawm ib nrab-lub neej ze 2 teev. Txawm li cas los xij, anti-Xa cov khoom tshwm sim tsawg kawg 18 teev.
Cov tshuaj txiav tawm hauv daim siab desulfation thiab depolymerization.

Kev ntsuas rau siv

Rooj Siv Ceeb Toommuaj teeb meem thromboembolic(tom qab kev orthopedic thiab kev phais, nyob rau hauv cov neeg uas muaj kev pheej hmoo ntawm thrombosis, kev txom nyem plawv lossis ua pa tsis ua hauj lwmmob hom).

Cov Yuav Tsum Tau Ua

Ntshav lossis nws muaj feem raug mob hnyav zuj zus ntxiv nrog qhov zuj zus hemostasis.
Thrombocytopenia thaum noj nadroparinyav tag los.
Lub cev puas tsuaj nrog qhov kev pheej hmoo los ntshav.
Lub hnub nyoog txog 18 xyoo.
Hnyav lub raum tsis ua hauj lwm.
Intracranial hemorrhage.
Raug mob los yog kev khiav hauj lwm rau tus txha nqaj qaum thiab mob hlwb los yog rau ntawm lub qhov muag.
Ntse mob endocarditis.
Kev ua haujlwm tsis zoo rau cov khoom lag luam.

Siv nrog ceev faj thaum: hepatic lossis lub raum tsis ua hauj lwm, tawgloj, nrog peptic mobnyob rau yav dhau los lossis lwm yam kabmob nrog kev pheej hmoo ntshav ntau ntxiv, hloov pauv hloov ntshav hauv ocular choroid thiab retina, tom qab kev phais mob, hauv cov neeg mob hnyav txog 40 kg, yog hais tias lub sijhawm kho tau tshaj 10 hnub, tsis ua raws li cov kev cai pom zoo, thaum ua ke nrog lwm yam tshuaj thaiv tsev.

Sab sij huam

Cov tshuaj tiv thaiv los ntawm coagulation system: los ntshav ntawm ntau lub chaw.
Cov tshuaj tiv thaiv los ntawm cov kab mob hematopoietic: thrombocytopenia, eosinophilia.
Cov tshuaj hepatobiliary: muaj ntau ntaudaim siab enzymes.
Cov tshuaj tiv thaiv los ntawm lub cev tiv thaiv kab mob: kev tiv thaiv tsis haum.
Cov kev hloov hauv zos: kev tsim ntawm ib qho me me subcutaneous hematomas nyob rau hauv thaj chaw txhaj tshuaj, cov duab tshwm ntawm cov qauv tsim tau zoo uas yuav ploj mus tom qab ob peb hnub, necrosis tawv nqaij hauv thaj tsam ntawm kev tswj hwm. Hauv cov xwm txheej no, kev kho nrog Fraxiparin yuav tsum tsis ua mus ntxiv.
Lwm yam kev cuam tshuam: hyperkalemia, priapism.

Noj ntau dhau

Kev Kho Mob: kev los ntshav me me tsis xav tau kev kho mob (tsuas yog txhaj qis dua lossis ncua sijhawm ntxiv tom qab). Cov Tshuaj Sulfate nruab nrab anticoagulant ntawv heparinCov. Nws siv yog qhov tsim nyog tsuas yog muaj mob hnyav. Koj yuav tsum paub tias 0.6 ml protamine sulfate nruab nrab kwv yees li 950 tawm tsam los tiv thaiv Ha ME nadroparin.

Kev sib txuam

Kev phom sij ntawm qhov tshwm sim hyperkalemiance ntxiv thaum ua ke nrogcov kab mob ntsev, ACE inhibitors, potassium-sparing diuretics, angiotensin receptor blockers, heparins, tsis siv tshuaj tiv thaiv tsis haum tshuaj, tacrolimus, cyclosporine, trimethoprim.

Sib koom siv nrog acetylsalicylic acid, tsis ncaj rau anticoagulants, NSAIDs, fibrinolytics lossis dextran ob leeg ntxiv dag zog rau qhov cuam tshuam ntawm cov tshuaj.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Fraxiparin muaj nyob rau hauv daim ntawv ntawm kev daws rau kev tswj hwm subcutaneous (sc): cov kua dej ntshiab lossis tsis sib luag, tsis muaj xim lossis lub teeb daj (ntawm koob ntawm 0.3 ml, 0.4 ml, 0.6 ml, 0.8 ml lossis 1 ml nyob rau hauv lub khob iav uas tso tseg, 2 cov koob txhaj tshuaj hauv lub hlwv, hauv ib daim ntawv me me ntawm 1 lossis 5 hlwv).

1 ml ntawm cov tshuaj muaj:

cov tshuaj nquag: calcium nadroparin - 9500 ME (chav thoob ntiaj teb) tiv thaiv Xa,
Cov khoom ua haujlwm pabcuam: calcium hydroxide tov (lossis dilute hydrochloric acid), dej rau kev txhaj tshuaj.

Hauv 1 koob txhaj, cov ntsiab lus calcium ntawm nadroparin nyob ntawm nws lub ntim thiab sib raug rau cov nyiaj hauv qab no:

ntim 0.3 ml - 2850 ME tiv thaiv Xa,
ntim 0.4 ml - 3800 ME tiv-Xa,
ntim 0.6 ml - 5700 ME tiv-Xa,
ntim 0.8 ml - 7600 ME tiv-Xa,
1 ml ntim - 9500 ME tiv-Xa.

Cov Tshuaj Pharmacokinetics

Kev txiav txim siab ntawm cov qauv pharmacokinetic yog raws cov kev hloov pauv hauv qhov cuam tshuam anti-Xa yam kev ua haujlwm ntawm ntshav.

Tom qab kev tswj fwm, nce txog 88% nadroparin yog nqus, qhov siab tshaj plaws tiv thaiv Xa-kev ua haujlwm (C_max) tau mus txog hauv 3-5 teev. Nrog rau / hauv kev qhia ntawm C_max tshwm sim hauv tsawg dua 1/6 ntawm ib teev.

Nws yog metabolized hauv daim siab ua rau ntau dua los ntawm depolymerization thiab desulfation.

T_{1/2 (}tshem tawm ib nrab-lub neej) nrog kev tswj hwm iv - txog 2 teev, nrog s / c - txog 3.5 teev. Ntxiv mus, tiv thaiv Xa-cov haujlwm tom qab kev tswj hwm sc hauv ib koob ntawm 1900 ME tiv thaiv Xa-mob tseem muaj tsawg kawg 18 teev.

Hauv cov neeg laus cov neeg mob, hloov kho koob tshuaj yog ua raws li lub hnub nyoog muaj feem cuam tshuam ntawm lub cev hloov kho ntawm lub raum.

Thaum Fraxiparin raug tshuaj rau kev kho mob tsis txaus ntseeg angina, myocardial infarction tsis muaj Q yoj los yog thromboembolism hauv cov neeg mob uas mob me los sis mob raum tsis ua haujlwm nrog creatinine tshem tawm (CC) los ntawm 30 ml / min txog 60 ml / min, qhov koob tshuaj yuav tsum raug txo 25%. Hauv cov neeg mob uas mob raum tsis ua haujlwm, kev teem sijhawm yog contraindicated.

Rau kev tiv thaiv ntawm thromboembolism hauv cov neeg mob uas mob raum tsis txaus los yog mob raum, kev txhaj tshuaj nadroparin tsis tas yuav tsum tau, nrog kev mob raum tsis ua haujlwm, qhov koob tshuaj yuav tsum raug txo 25%.

Kev qhia txog kev txhaj tshuaj siab ntawm lub cev tsis tshua muaj qhov hnyav hnyav heparin rau hauv txoj hlab ntshav ntawm lub voj voos lim ntshav txwv tsis pub cov ntshav txhaws hauv lub voj voos lim ntshav. Thaum muaj kev noj tshuaj ntau dhau, kev noj kom tsawg ntawm Fraxiparin mus rau hauv cov kab ke kev muaj zog tuaj yeem ua rau muaj qhov nce ntawm anti-Xa yam ua rau cuam tshuam nrog cov theem kawg ntawm kev ua haujlwm raum.

Cov lus qhia tshwj xeeb

Tsis txhob txhaj cov tshuaj intramuscularly!

Thaum kho nrog Fraxiparin, nws txoj kev hloov kho nrog lwm cov tshuaj teej tug mus rau chav kawm ntawm tsis tshua muaj molecular hnyav heparin tsis tuaj yeem lees txais. Qhov no yog vim ib qho ua txhaum txoj cai ntawm cov tshuaj ntau npaum li cas vim kev siv ntau npaum cov sib txawv ntawm cov tshuaj.

Cov koob txhaj tshuaj tso cai kawm tso cai rau koj kom raug xaiv qhov kev noj tshuaj ib leeg, suav txog tus neeg mob lub cev qhov hnyav.

Cov tsos mob ntawm tus mob necrosis hauv thaj chaw ntawm kev daws teeb meem feem ntau yog purpura, qhov hnov mob erythematous lossis mob siab ntxiv (suav nrog cov tsos mob dav dav). Yog tias lawv tshwm sim, tsum tsis txhob siv Fraxiparin tam sim ntawd.

Heparins ua rau kom muaj kev pheej hmoo ntawm thrombocytopenia, yog li kev kho yuav tsum tau nrog ua tib zoo saib xyuas ntawm platelet suav. Kev xyuam xim tshwj xeeb yuav tsum tau tawm dag zog, thiab yog tias cov xwm txheej hauv qab no tshwm sim, kev kho mob yuav tsum tau nres tam sim ntawd: thrombocytopenia, qhov cim poob (30-50% ntawm tus nqi pib) ntawm platelet suav, tsis zoo lub zog ntawm thrombosis uas tau kho, thiab thrombosis tsim thaum tswj hwm cov tshuaj , tshaj tawm cov lus kev mob kev pheej hmoo ntawm kev mob txha mus ib ce.

Yog tias tsim nyog, Fraxiparin yuav raug tshuaj rau cov neeg mob uas muaj keeb kwm ntawm heparin-vim raug mob thrombocytopenia uas tau tshwm sim thaum siv los ua lub cev tsis haum lossis qis molecular hnyav heparins. Hauv qhov no, txhua hnub platelet suav yog muaj qhia. Yog tias thrombocytopenia tshwm sim, koj yuav tsum tso tseg kev siv tshuaj tam sim ntawd thiab txiav txim siab txog kev teem caij tshuaj tiv thaiv ntawm lwm pab pawg.

Kev teem caij ntawm Fraxiparin yuav tsum yog ua rau tsuas yog suav txog qhov tshwm sim ntawm kev ntsuas ntsuas ntawm kev ua haujlwm lub raum.

Tawm tsam keeb kwm yav dhau los ntawm kev siv tshuaj heparin hauv cov neeg mob uas muaj ntau ntxiv ntawm cov potassium nyob rau hauv cov ntshav los yog qhov kev pheej hmoo ntawm kev ua kom cov poov tshuaj ntau ntxiv hauv cov ntshav, qhov yuav ua rau muaj hyperkalemia nce ntxiv. Hauv qhov no, nrog txoj kev kho mob ntev lossis kev kho mob ntawm cov neeg mob uas mob raum tsis ua haujlwm, mob ntshav qab zib mellitus, metabolic acidosis lossis cov neeg tau txais kev kho mob concomitant nrog angiotensin hloov enzyme inhibitors (ACE), tsis siv tshuaj tiv thaiv tsis haum tshuaj (NSAIDs) thiab lwm yam tshuaj uas pab txhawb kev txhim kho hyperkalemia, nws yog qhov yuav tsum tau ua tib zoo soj ntsuam cov theem ntawm poov tshuaj nyob rau hauv cov ntshav.

Qhov kev txiav txim siab ntawm qhov ua tau ntawm kev sib xyaw ntawm cov tshuaj tiv thaiv nrog neuroaxial blockade yog tsim nyob ntawm tus kheej raws li qhov ntsuas ntawm qhov sib piv ntawm cov txiaj ntsig thiab kev pheej hmoo ntawm kev sib xyaw no.

Thaum coj tus mob txha caj qaum thiab epidural anesthesia lossis lumbar puncture, lub sijhawm nruab nrab ntawm kev tswj hwm tshuaj thiab kev qhia tawm lossis tshem tawm tus txha caj qaum lossis epidural koob lossis hno quav. Thaum siv Fraxiparin rau kev tiv thaiv ntawm thromboembolism, nws yog tsawg kawg 12 teev, rau lub hom phiaj ntawm kev kho mob - 24 teev. Hauv raum tsis ua haujlwm, lub caij nyoog ntxiv yog nce.

Thaum tsis ua haujlwm lub raum

Rau kev kho mob ntawm thromboembolism, tsis khov tsis khov lossis myocardial infarction tsis muaj Q yoj, kev tswj hwm ntawm nadroparin calcium tov yog tsis pom kev hauv cov neeg mob uas mob raum tsis zoo (CC tsawg dua 30 ml / min). Nrog CC ntawm 30-60 ml / min, cov koob tshuaj yog txo 25%.

Thaum siv Fraxiparin rau kev tiv thaiv ntawm thrombosis hauv cov neeg mob uas lub raum tsis ua haujlwm, qhov kev txo qhov koob tshuaj tsis tas yuav tsum muaj CC ntawm 30-60 ml / min, nrog CC tsawg dua 30 ml / min - nws yuav tsum tau txo 25%.

Yeeb tshuaj sib cuam tshuam

Nrog kev siv tib lub sijhawm ntawm Fraxiparin:

tsis yooj yim lossis qis molecular hnyav heparins, potassium-sparing diuretics, ntsev ntsev, angiotensin II receptor blockers, cyclosporin, tacrolimus, trimethoprim, ACE inhibitors, NSAIDs: ua rau muaj kev pheej hmoo ntawm hyperkalemia,
cov tshuaj uas cuam tshuam rau hemostasis (tsis ncaj rau anticoagulants, dextran, fibrinolytics, acetylsalicylic acid, NSAIDs): ua rau muaj kev sib koom tes ntxiv hauv kev nqis tes ua,
acetylsalicylic acid (ntawm koob tshuaj 50-300 mg rau lub cim tshuaj rau lub plawv los yog neurological), abciximab, clopidogrel, beraprost, iloprost, eptifibatide, tirofiban, ticlopidine: lawv muaj qhov cuam tshuam rau kev pheej hmoo ntshav tawm los,
tsis ncaj ntawm cov tshuaj tiv thaiv, dextrans, kab ke glucocorticosteroids: yuav tsum siv nrog ceev faj. Tom qab cov thawj coj ntawm cov tshuaj tua kab mob tsis ncaj, kev siv Fraxiparin yuav tsum txuas ntxiv mus kom txog thaum MHO xav kom ua tiav (Kev Ntsuas Cov Nyiaj Txiag Tebchaws International Normalized Ratio) tau tiav.

Cov lus piv txwv ntawm Fraxiparin yog: Fraxiparin Forte, Atenativ, Fragmin, Wessel Douay F, Kleksan, Heparin, Heparin-Darnitsa, Heparin-Biolek, Heparin-Indar, Heparin-Farmeks, Heparin-Novofarm, Novoparin, Tsibor, Enoks.

Cov chaw muag tshuaj

Mechanism ntawm kev ua
Calcium nadroparin yog cov muaj zog hnyav molecular heparin (LMWH) tau los ntawm depolymerization los ntawm tus qauv heparin. Nws yog glycosaminoglycan nrog qhov nruab nrab molecular hnyav ntawm kwv yees li 4300 daltons.
Nadroparin tso saib muaj peev xwm loj khi rau plasma protein nrog antithrombin III (AT III). Qhov khi no ua rau nrawm nrawm ntawm qhov Xa. uas yog vim muaj lub siab antithrombotic muaj peev xwm ntawm nadroparin. Lwm cov txheej txheem muab cov txiaj ntsig antithrombotic ntawm nadroparin. suav nrog kev ua kom cov nqaij mos hloov dua siab tshiab (TFPI), kev ua haujlwm ntawm fibrinogenesis los ntawm kev tso tawm ntawm cov nqaij mos plasminogen los ntawm cov hlwb endothelial, thiab kev hloov kho ntawm cov ntshav rheology (txo cov ntshav viscosity thiab nce ntxiv hauv permeability ntawm platelet thiab granulocyte membranes).

Cov Tshuaj Hauv Tshuaj
Nadroparin yog qhov tshwj xeeb los ntawm kev ua haujlwm ntau dua rau qhov sib piv ntawm XA, piv nrog kev ua haujlwm tiv thaiv tus lej IIa. Nws muaj ob qho tib si tam sim ntawd thiab lub sijhawm ua haujlwm antithrombotic.
Muab piv rau cov tshuaj heparin tsis sib haum xeeb, nadroparin muaj cov nyhuv qis dua ntawm cov platelet muaj nuj nqi thiab ntawm kev sib sau ua ke thiab muaj cov nyhuv me ntawm thawj cov kab mob hemostasis.
Hauv kev txhaj tshuaj prophylactic, nws tsis ua rau lub suab txo qis hauv ntu thrombin lub sijhawm (APTT).
Nrog rau kev kho mob lub sijhawm lub sijhawm ua haujlwm siab tshaj plaws, APTT tuaj yeem txuas ntxiv kom tus nqi 1.4 npaug siab dua li tus qauv. Xws li lub caij nyoog ntev ua kom pom qhov seem antithrombotic ntawm cov calcium calcium nadroparin.

Cov Tshuaj Pharmacokinetics
Cov cuab yeej pharmacokinetic tau txiav txim siab los ntawm cov kev hloov pauv ntawm qhov cuam tshuam anti-Xa yam kev ua haujlwm ntawm ntshav.
Kev Tsis Txaus Siab
Tom qab tswj hwm subcutaneous, qhov siab tshaj plaws tiv thaiv Xa-cov haujlwm (C_max) ua tiav tom qab 35 teev (T_max).
Bioavailability
Tom qab kev tswj hwm subcutaneous, nadroparin yog yuav luag nqus tag nrho (li ntawm 88%).
Nrog kev tswj hwm kev tswj hwm, qhov siab tshaj tawm ntawm kev ua haujlwm tiv thaiv Xa-tau ua tiav nyob hauv tsawg dua 10 feeb, ib nrab-lub neej (T_½ ) yog txog 2 teev.
Kev zom zaub mov
Kev mob ntshav siab tshwm sim hauv cov nplooj siab (desulfation, depolymerization).
Chaw Sau Ntawv
Ib nrab-lub neej tom qab kev tswj hwm subcutaneous yog li 3.5 teev. Txawm li cas los xij, cov haujlwm tiv thaiv Xa-mob tseem muaj tsawg kawg 18 teev tom qab txhaj tshuaj nadroparin ntawm koob tshuaj 1900 los tiv thaiv XA ME.

Cov pab pawg muaj kev pheej hmoo

Cov neeg laus cov neeg mob
Hauv cov neeg mob laus, vim tias qhov ua kom lub raum txo qis dua, kev tshem tawm nadroparin tuaj yeem qeeb. Kev raum tsis ua hauj lwm hauv cov neeg mob no yuav tsum muaj kev soj ntsuam thiab kev hloov tshuaj kom tsim nyog.

Cov neeg mob uas lub raum tsis ua hauj lwm zoo
Hauv kev tshawb fawb txog kev kho mob ntawm pharmacokinetics ntawm nadroparin thaum muab tshuaj rau cov neeg mob raum tsis ua haujlwm ntawm qhov mob tsis zoo, ib qho kev sib txuam tau tsim los ntawm kev tshem tawm ntawm nadroparin thiab kev tshem tawm ntawm creatinine. Thaum muab piv rau cov txiaj ntsig tau nrog rau cov neeg tuaj yeem noj qab haus huv, tau pom tias AUC thiab ib nrab-lub neej tau nce mus txog 52-87%, thiab creatinine tshem tawm mus rau 47-64% ntawm cov nuj nqis ib txwm muaj. Txoj kev tshawb fawb kuj tseem pom qhov txawv ntawm cov tib neeg. Hauv cov neeg mob uas mob raum tsis ua haujlwm, ib nrab ntawm lub neej ntawm nadroparin nrog kev coj noj coj ua tau nce mus rau 6 teev.Cov txiaj ntsig ntawm txoj kev tshawb no pom tau tias kev nadroparin muaj peev xwm pom tau hauv cov neeg mob uas tsis tshua mob pes tsawg lossis mob raum tsis ua haujlwm (tus kabmob tshem tawm muaj ntau dua lossis sib npaug ntawm Som / min thiab qis dua 60 ml / min), yog li ntawd, koob tshuaj Fraxiparin yuav tsum raug txo 25% hauv cov neeg mob uas tau txais Fraxiparin rau kev kho mob ntawm thromboembolism, tsis khov kho angina pectoris / myocardial infarction tsis muaj Q yob. Fraxiparin yog sib kis hauv cov neeg mob uas mob raum tsis ua haujlwm, thiaj li kho tau cov mob no.
Hauv cov neeg mob uas mob raum tsis tshua mob pes tsawg lossis qis qis, kev siv Fraxiparin rau kev tiv thaiv ntawm thromboembolism, kev txuam nrog nadroparin tsis ntau tshaj qhov ntawd rau cov neeg mob uas lub raum tsis ua haujlwm, noj tshuaj rau ntawm Fraxiparin. Yog li no, txo qhov koob tshuaj Fraxiparin noj rau lub hom phiaj prophylactic hauv pawg no ntawm cov neeg mob tsis tas yuav tsum. Hauv cov neeg mob uas lub raum tsis ua haujlwm uas tau txais prophylactic fraxiparin, qhov yuav txo qhov ntau npaum li 25% yog tsim nyog piv nrog cov koob tshuaj uas tau muab rau cov neeg mob uas muaj creatinine ntshiab si.
Hemodialysis
Tsawg molecular hnyav heparin tau nkag mus rau hauv txoj hlab ntshav ntawm lub voj voos lim ntshav hauv qhov siab txaus kom tiv thaiv cov ntshav coagulation nyob rau hauv lub voj. Cov chaw muag tshuaj tsis hloov pauv hloov pauv, tshwj tsis yog kis ntawm kev noj tshuaj ntau dhau, thaum txoj kev tso tshuaj rau hauv cov ntshav ncig yuav ua rau muaj qhov nce ntawm anti-Xa yam ua rau cuam tshuam nrog cov theem kawg ntawm lub raum tsis ua haujlwm.

Tsuas tshuaj thiab tswj hwm

Cov tshuaj Fraxiparin yog npaj rau subcutaneous thawj coj. Qhov ntau npaum li cas ntawm cov tshuaj thiab lub sijhawm ntawm cov chav kawm ntawm kev kho mob yog txiav txim los ntawm tus kws kho mob, nyob ntawm qhov ntsuas thiab cov yam ntxwv ntawm tus neeg mob lub cev.

Feem ntau, qhov chaw anterolateral ntawm lub plab lossis ncej puab yog xaiv rau kev txhaj tshuaj. Daim tawv nqaij yog txhom tau hauv cov pob taws thiab nruab nrab ntawm qhov taw qhia ntiv tes thiab tus ntiv tes xoo thiab lub koob tau ntxig txiav kom ncaj rau ntawm daim tawv nqaij.

Txhawm rau tiv thaiv txoj kev loj hlob ntawm thromboembolism tom qab kev phais mob, 0.3 ml ntawm Fraxiparin siv 2-4 teev ua ntej kev phais mob, thiab tom qab ntawd rau ntau hnub ib hnub ib hnub, tsawg kawg 7 hnub.

Siv thaum cev xeeb tub thiab lactation

Kev siv cov tshuaj Fraxiparin thaum cev xeeb tub tsis pom zoo, vim tias kev kho mob hauv chaw kho mob muaj tsawg. Hauv chav kawm ntawm kev tshawb fawb tsiaj, teratogenic lossis embryotoxic nyhuv ntawm cov tshuaj ntawm cov menyuam hauv plab tsis tau tsim, txawm li cas los xij, txawm hais tias cov ntaub ntawv no, cov tshuaj tsis raug qhia rau cov poj niam ua menyuam. Yog tias tsim nyog, tus kws kho mob ntsuas qhov feem ntawm qhov yuav muaj txiaj ntsig thiab kev pheej hmoo rau leej niam thiab tus menyuam hauv plab.

Thaum lub sijhawm lub sijhawm pub niam mis, cov tshuaj Fraxiparin tsis tau hais rau leej niam, vim nws tsis paub txog lub peev xwm ntawm cov tshuaj tau tawm hauv cov kua mis. Yog tias nws yog qhov tsim nyog los muab tshuaj rau ntawm Fraxiparin rau leej niam uas pub mis, lactation yuav tsum cuam tshuam thiab tus menyuam yuav tsum pauv mus rau khoom noj khoom haus khoom noj khoom haus nrog kev sib tov mis nyuj sib xyaw.

Sab sij huam

Raws li txoj cai, cov tshuaj tau txais txiaj ntsig zoo los ntawm cov neeg mob, tab sis qee qhov xwm txheej, kev txhim kho cov kev tsis haum yog qhov ua tau:

los ntawm coagulation system ntawm cov ntshav - los ntshav ntawm ntau yam laus,
los ntawm cov ntshav hematopoietic plab hnyuv siab raum - txo qis ntawm platelets thiab eosinophilia, uas sai sai ntawm lawv tus kheej tom qab tso tseg kev kho tshuaj
los ntawm kev tiv thaiv kab mob - urticaria, maj ntshav ntshav mus rau lub ntsej muag, kev hnov mob ntawm tshav kub hauv lub taub hau, angioedema, dermatitis,
mob siab, nce kev ua haujlwm ntawm hepatic transaminases,
cov tshuaj tiv thaiv hauv zos - qhov tsim ntawm subcutaneous hematomas ntawm qhov chaw txhaj tshuaj, cov tsos ntawm kev mob siab rau hauv qab daim tawv nqaij, liab ntawm daim tawv nqaij ncig thaj chaw txhaj tshuaj, daim tawv necrosis ntawm qhov chaw txhaj tshuaj.

Yog tias muaj kev mob tshwm sim, koj yuav tsum tau sab laj nrog kws kho mob kom pab tswv yim.

So haujlwm thiab chaw mob

Cov tshuaj Fraxiparin tau raug faib tawm los ntawm cov khw muag tshuaj los ntawm cov tshuaj. Khaws cov koob txhaj tshuaj nrog cov yeeb tshuaj kom deb ntawm cov menyuam yaus, kom deb ntawm qhov chaw ntawm tshav kub thiab lub teeb. Lub txee lub neej ntawm cov tshuaj yog qhia hauv pob thiab yog 2 xyoos txij li hnub ua khoom siv.

Tsis txhob siv txoj hauv kev daws rau kev tswj hwm yog tias kev ncaj ncees ntawm lub pob tau txais kev cuam tshuam.

Tsis ruaj khov angina pectoris thiab myocardial infarction tsis muaj Q yoj

Fraxiparin raug tswj hwm txhua 12 teev. Lub sijhawm siv, raws li txoj cai, yog 6 hnub. Thaum lub sijhawm sim tshuaj, cov tshuaj tau sau ua ke nrog acetylsalicylic acid (325 mg ib hnub).

Qhov muab tshuaj thawj zaug yuav tsum raug muab raws li kev txhaj tshuaj ib qho tshuaj txhaj ib zaug, tom qab ua s / c.

Qhov koob tshuaj yog txiav txim los ntawm qhov hnyav - 86 anti-XA IU / kg.

Kev tiv thaiv ntawm cov ntshav coagulation nyob rau hauv extracorporeal ncig cov ntshav thaum lub sij hawm hemodialysis

Cov koob tshuaj ntawm Fraxiparin yog txiav txim siab ib tus zuj zus, suav txog qhov teeb meem ntawm kev lim ntshav ntawm lub cev.

Thaum pib ntawm txhua ntu, Fraxiparin yuav tsum qhia ib zaug rau ntawm txoj kab ntawm txoj hlab ntshav ntawm lub voj voos. Rau cov neeg mob uas tsis muaj kev pheej hmoo ntxiv los ntshav, thawj zaug koob tshuaj tau teem raws qhov hnyav, tab sis tsim nyog rau plaub-teev: