Coumadin vs. heparin: Misiyano, kufanana, uye izvo zviri nani kwauri
Zvinodhaka Vs. ShamwariKuongorora kwezvinodhaka & misiyano mikuru | Conditions kurapwa | Kubudirira | Inishuwarenzi kufukidza uye mutengo kuenzanisa | Zvimwe zvinokanganisa | Kubatana kwezvinodhaka | Yambiro | MIBVUNZO
Anticoagulation therapy inoita basa rakakosha mukutungamira kwemamiriro akakomba senge atrial fibrillation, venous thromboembolism, uye mehendi yemoyo vharuvhu kuiswa. Iyo anticoagulant mishonga Coumadin uye heparin inobatsira kugadzirisa uye kudzivirira kuumbwa kweropa clots izvo zvinogona kuuraya mune aya mamiriro.
Vitamin K chinhu chakakosha munzira yekuvhara kugadzirwa. Inodikanwa mukutangisa kwekushamisa kwekuvharisa zvinhu II, VII, IX, uye X. Kana ichinge yashandiswa mukuumbanidzwa kweaya anovharisa ropa, vhitamini K inogumiswa uye inofanira kuitwazve vhitamini K epoxide reductase yakaoma 1 (VKORC1) kuitira kuti uenderere mberi kutora chikamu mune yekuumbika maitiro maitiro. Coumadin inodzivisa chikamu cheiyo VKOR yakaoma uye nekudaro inobatsira pakupera kwevhitamini K mumuviri, izvo zvinoderedza kugona kwemuviri kugadzira clots.
Heparin inoshanda nekusunga kune protein antithrombin III iyo inozo gonesa thrombin uye nezvimwe zvinogumbura zvinhu, zvinonyanya kukosha chinhu Xa. Aya matanho anodzivisa kushandurwa kwe fibrinogen kuita fibrin, nhanho yakakosha mukuumbika kwekuumbika. Nekunonoka kuumbwa kwe fibrin, heparin inoderedza kugadzirwa kwemuviri mumuviri.
Ndeupi mutsauko mukuru pakati peCoumadin ne heparin?
Coumadin mushonga wekunyorerwa unowanzodanwa nezita rawo, warfarin, kana dzimwe nguva Jantoven. Inoshandiswa kudzivirira kuumbika kweropa rakagwamba mumamiriro ezvinhu senge atrial fibrillation, sitiroko, myocardial infarction, uye venous thromboembolism. Inowanikwa sehwendefa remuromo mune akasiyana madosi kubva 1mg kusvika 10mg pahwendefa. Ndichiri paCoumadin, varwere vanofanirwa kuzviisa kune zvakajairwa prothrombin bvunzo (PT) inonzi seInternational Normalized Ratio (INR) kuona kana chirwere chemurwere chakakodzera kurapwa. Warfarin haigone kushandiswa muvarwere isingasviki mwedzi mina yezera nekuda kwehutongi nyaya uye mukana weasina kuzivikanwa majini zvinhu zvinogona kukanganisa kunzwisisika.
Heparin imishonga inonyorwa inonyanyo shandiswa munzvimbo yevanorwara. Inoshandiswa kudzivirira kuumbika kweropa rakagwamba mumamiriro akadai seakadzika venous thrombosis, pulmonary embolism, uye atrial fibrillation. Iyo inoshandiswa zvakare kudzivirira kugadzirwa kwemagadziko panguva yemaitiro anosanganisira moyo nemidziyo yeropa. Heparin inowanikwa mune dzakasiyana mhinduro mafomu eiyo intravenous majekiseni kana infusions. Iko kune yakasarudzika fomati yeparparin inoitirwa chete mutsinga inoyerera yekudzivirira kudzivirira kuumbika mumutsara. Izvi zvinonzi heparin lock flush, uye uku kugadzirwa hakufanirwe kushandiswa kune chero chimwe chinangwa. Heparin inogona kushandiswa kune varwere vechero zera, asi padyo kutarisa kunodiwa.
| Misiyano mikuru pakati peCoumadin neHeparin | ||
|---|---|---|
| Coumadin | Heparin | |
| Kirasi yemishonga | Anticoagulant | Anticoagulant |
| Brand / generic chinzvimbo | Brand uye generic inowanikwa | Brand uye generic inowanikwa |
| Chii chinonzi generic zita? Chii chinonzi zita rechiratidzo? | Warfarin Coumadin | Heparin |
| Ndeapi mafomu (s) ayo mushonga unouya? | Hwendefa (akawanda masimba) | Solution yejekiseni kana infusion (kuwanda kuwanda kunowanikwa) |
| Ndeipi muyero wakajairwa? | Vazhinji varwere vanotanga pa5 mg zuva nezuva, asi yekuchengetedza dosi kunoenderana nemurwere wega INR | Wepakati murwere mukuru anozogashira yekuregedza muyero we5,000 mayuniti inoteverwa ne20,000 kusvika 30,000 mauniti pamusoro peawa makumi maviri nemana mukuwedzera infusion |
| Inguva yakareba sei kurapwa kwacho? | Minimum yemwedzi mitatu, asi inogona kuve isingazivikanwe zvichienderana nechiratidzo | Kazhinji mazuva mashoma, kusvika pasvondo |
| Ndiani anowanzoshandisa mushonga? | Vakuru | Vakuru |
Mamiriro ezvinhu akarapwa naCoumadin uye heparin
Coumadin inoshandiswa kudzivirira uye kurapa venous thromboembolism uye pulmonary embolism pamwe necoagulation matambudziko anosangana neatrial fibrillation uye michina vheji kutsiva. Coumadin inoshandiswa zvakare kudzivirira kusangana kwakabatana kunosangana uko kunogona kutevera myocardial infarction kana chirwere chemwoyo.
Heparin inoshandiswa zvakare kudzivirira uye kurapa venous thromboembolism uye pulmonary embolism pamwe necoagulation zvinosangana zvine chekuita neatrial fibrillation. Uye zvakare, heparin inoshandiswa kudzivirira kugwamba mukuvhiya kwemoyo, kuwedzerwa ropa, uye dialysis maitiro.
| Mamiriro | Coumadin | Heparin |
| Venous thromboembolism | Ehe | Ehe |
| Pulmonary embolism | Ehe | Ehe |
| Atrial fibrillation | Ehe | Ehe |
| Mechanical vharafu kutsiva | Ehe | Ehe |
| Post-myocardial infarction matambudziko anosangana nekuvhara | Ehe | Kwete |
| Percutaneous coronary kupindira (angioplasty) | Kwete | Ehe |
| Kuisirwa ropa | Kwete | Ehe |
| Dialysis | Kwete | Ehe |
Coumadin kana heparin inoshanda zvakanyanya here?
Coumadin uye heparin vane misiyano inovapa imwe neimwe nzvimbo yakakosha pakurapa, kazhinji mumurwere mumwe chete.
Kubviswa kwehafu-yehupenyu uye nguva yekukwirisa kukoshesa zvinhu zviviri zvakakosha zvekuchipatara pakusarudza mashandisiro uye nguva yekushandisa mushonga wega. Coumadin inosvika pamusoro peplasma mazinga kubva kune imwe dhiza mune angangoita maawa mana, nekubvisa hafu-hupenyu hweanenge maawa makumi mana. Nekuda kwezvinhu zvinoverengeka zvinogona kusiyana nemurwere wega wega, zvinogona kutora mazuva kusvika kumavhiki kuti usvike yekurapa INR. Heparin inosvika pakakwirira kuwanda kweplasma mumaawa maviri kusvika kumana, iine hafu yeupenyu yekubvisa ingangoita 60-90 maminetsi.
Iyo mirayiridzo ye manejimendi yeakadzika vein thrombosis (DVT) uye pulmonary embolism yemarudzi mazhinji evarwere inokurudzira kushandiswa kwekutanga kwe heparin nekuda kwekukurumidza kwayo kutanga. Kubudirira kwekurapa kunoitwa nekupa iyo yekuregedza dhizaini inoteverwa neyekuchengetedza dosi. Izvi zvinoenderera mberi nepo Coumadin therapy inotangwa, uye kudzamara INR yemurwere ichirapa. Izvi zvinogona kutora mazuva 7-10. Heparin kazhinji inoda kutarisirwa munzvimbo yevanorwara, asi murwere anogona kuenda kumba kana vachinge vaendeswa kuCoumadin.
Mubatsiri wezvehutano chete ndiye anogona kuona kuti ndeupi mushonga, kana musanganiswa werapi, wakakodzera kune mumwe murwere. Vapiro vanofanirwa kufunga nezvezvakawanda zvinorwara-zvakasarudzika zvinhu, senge nhoroondo yekuvhara zviitiko, zera, kurapwa kwekutanga, uye nhoroondo yemamiriro ezvinhu akadaro heparin-induced thrombocytopenia.
Kuvhara uye mutengo kuenzanisa kweCoumadin vs. heparin
Mazhinji maMedare uye einishuwarenzi anoronga kufukidza Coumadin, uye / kana iro generic vhezheni warfarin. Mari yepakati yekutengesa yeCoumadin inogona kubva pamadhora makumi masere kusvika pamadhora zana nemakumi maviri emadhora. Iwe unogona kuwana warfarin yeinosvika madhora gumi neka SingleCare koponi.
Heparin inowanzo kupihwa munzvimbo yezvipatara uye inowanzo kufushirwa pasi Medicare Chikamu B . Kune vasiri-Medicare varwere, inovharwa neinishuwarenzi yekurapa kana ichifungidzirwa zvine musoro uye zvichidikanwa. Murwere anobuda muhomwe mutengo anoenderana nezvinhu zvakati wandei kusanganisira kuti vasangana here nezvavanobvisa uye kana vaine zvekuwedzera zvekuvhara. Kana murwere akaona kuti Heparin yavo haina kuvharwa, vanogona kurodha pasi coupon vobhadhara zvakaderera kunge $ 45 yemushonga.
| Coumadin | Heparin | |
| Kazhinji yakafukidzwa neinishuwarenzi? | Ehe | Ehe |
| Inowanzo kufukidzwa neMedare? | Ehe | Ehe, Chikamu B |
| Standard muyero | 30, 5 mg dose | 25 ml, 5000 unit / ml |
| Chaizvoizvo Medicare copay | Zvinosiyana | Zvinosiyana |
| SingleCare mutengo | $ 4- $ 14 | $ 45- $ 65 |
Zvakajairika mhedzisiro mhedzisiro yeCoumadin uye heparin
Kazhinji mhedzisiro Coumadin ese uye heparin inobuda ropa kana kubuda ropa kwakanyanya. Zvimwe zviratidzo zvekubuda ropa zvinogona kuoma kucherechedza, asi mashoma ezviratidzo zviri pachena anosanganisira kupwanya kuri nyore, kubuda ropa mumhino, kubuda ropa mumatadza, weti tsvuku kana yeruvara-ngura, uye ropa muziso. Kana murwere akatsunga kuve achibuda ropa, kubvisa mushonga kunodikanwa, kungave kuri kwenguva pfupi kana kwenguva refu.
Heparin-induced thrombocytopenia (HIT) yakataurwa mu 1-2% yevarwere vakapiwa heparin. Uku kudonha kwakanyanya muplatelet kuverenga kunogona kutungamira kumatambudziko akakomba senge tishu necrosis uye gonda rinokuvadza.
Kune zvimwe zvinonetsa uye zvakakomba mhedzisiro kubva pakurapwa naCoumadin kana heparin. Chiremba kana wemishonga anogona kupa rondedzero yakazara yemhedzisiro.
| Coumadin | Heparin | |||
| Side Migumisiro | Zvinoshanda? | Kakawanda | Zvinoshanda? | Kakawanda |
| Kubuda ropa | Ehe | 1-10% | Ehe | 1-10% |
| Gangrene / Ganda Necrosis | Ehe | <1% | Ehe | <1% |
| Thrombocytopenia | Kwete | Ehe | ≤30% | |
| HIT | Kwete | Ehe | 1-2% |
Iri rinogona kunge risiri runyorwa ruzere rwezviitiko zvakashata. Ndokumbirawo ubvunze chiremba kana wemishonga kuti uwane yakazara runyorwa.
Kwayaka: DailyMed ( Coumadin ), Zuva Nezuva ( heparin ).
Kubatana kwezvinodhaka zveCoumadin vs. heparin
Coumadin inogadziriswa ne cytochrome P450 enzymes, kunyanya subtypes 2C9, 1A2, uye 3A4. Inhibitors yeaya ma enzymes anonyanya kuwedzera Coumadin mazinga, nekudaro achiwedzera INR yemurwere uye achiwedzera njodzi yavo yekubuda ropa. Mienzaniso yeaya enzyme inhibitors anosanganisira antifungals senge fluconazole, uye yakakurumbira cholesterol mushonga, atorvastatin. Enzyme inducers inoderedza iwo mazinga eCoumadin, zvingangoita murwere INR subtherapeutic uye kuwedzera kudzingirira kwechiitiko chinotyisa. Mienzaniso ye enzyme inducers inosanganisira iyo inorwisa-kubvuta mishonga carbamazepine uye phenobarbital.
Mhedzisiro yeparparin inogona kuve inogona kuitwa neantiplatelet zvinodhaka seNSAIDs. Ibuprofen angave ari muenzaniso. Heparin mhedzisiro inogona kudzikiswa nekudyidzana neakajairika maantibhakitiriya senge doxycycline.
Iyi tafura inotevera haisi yeinosanganisira ese runyorwa rwekudyidzana. Wehutano wako mupi anogona kupa yakanyanya yakazara runyorwa uye nerumwe ruzivo pane yega yekudyidzana.
| Zvinodhaka | Kirasi Yezvinodhaka | Coumadin | Heparin |
| Amiodarone Propafenone | Antiarrhythmic | Ehe | Kwete |
| Fluconazole Itraconazole Ketoconazole Miconazole Voriconazole | Anti-fungal | Ehe | Kwete |
| Phenobarbital Carbamazepine | Anticonvulsant | Ehe | Kwete |
| Cimetidine Famotidine Ranitidine | Antacids | Ehe | Kwete |
| Ciprofloxacin Norfloxacin | Fluoroquinolone Mishonga inorwisa mabhakitiriya | Ehe | Kwete |
| Clarithromycin Erythromycin Telithromycin | Macrolide Mishonga inorwisa mabhakitiriya | Ehe | Kwete |
| Doxycycline Minocycline | Tetracycline Mishonga inorwisa mabhakitiriya | Kwete | Ehe |
| Atorvastatin Fluvastatin Simvastatin | HMG Co-A Reductase Inhibitors (Statins) | Ehe | Kwete |
| Estrogen uye Progestin Kusanganiswa | Mishonga yekudzivirira | Ehe | Ehe |
| Apixaban Rivaroxaban powder Edoxaban | Ropa rakatetepa | Kwete | Ehe |
| Ibuprofen Naproxen | NSAID | Ehe | Ehe |
| Celecoxib Meloxicam | Cox II Inhibitor | Ehe | Ehe |
Yambiro dzeCoumadin uye heparin
Coumadin uye heparin inogona imwe neimwe kuwedzera kuitika kwechiitiko chekubuda ropa. Mimwe mishonga inogona kuwedzera mukana weizvi zvichiitika. Varwere paCoumadin vanofanirwa kunge vaine INR yavo kuongororwa nguva nenguva. Kudya kwakanyanya kwevhitamini K, iri mune zvekudya zvakawanda senge miriwo yakasvibira yemashizha, inogona kudzora kushanda kweCoumadin. Varwere vanofanirwa kuchengetedza kudya kwezuva nezuva kweVitamin K vachiri kuCoumadin kuitira kuti vachengetedze INR yekurapa. Coumadin inopesana nepamuviri.
Heparin-induced thrombocytopenia inowanikwa mu1% kusvika 2% yevarwere uye chiitiko chakakomba chinotungamira mukuparadzwa kwemaplatelet. Izvi zvinogona kutungamira mukukuvara uye ganda necrosis kana risina kubatwa munguva.
Inowanzo bvunzwa mibvunzo nezve Coumadin vs. heparin
Chii chinonzi Coumadin?
Coumadin inorapwa anticoagulant mushonga unoshandiswa pakurapa uye prophylaxis ye venous thrombosis uye pulmonary embolism. Iyo zvakare inoshandiswa kugadzirisa zvinovhara zvinovhara zvinoenderana neatrial fibrillation uye yemoyo stent kuiswa. Inotorwa nemuromo kazhinji kamwe pazuva, uye varwere vanofanira kuve neINR yavo ichitariswa nguva dzese kuti vaone kuti yavo Coumadin dose yakakodzera.
Chii chinonzi heparin?
Heparin inorwisa anticoagulant inopihwa mukati mechipatara. Iyo inoshandiswa pakurapa uye prophylaxis ye venous thrombosis uye pulmonary embolism. Iyo inoshandiswawo kugadzirisa zviitiko zvekugwamba panguva yemoyo uye neoparesheni nzira dzekuvhiya. Varwere vanowanzo gashira yekurodha inoteverwa neiyo infusion, iyo inogona kutora mazuva akati wandei zvichienderana nemushonga.
Coumadin uye heparin zvakafanana here?
Ipo Coumadin uye heparin ese ari maviri anticoagulant mishonga, iwo haana kufanana. Coumadin imushonga wenyanzvi wemushonga unonyanya kushandiswa munzvimbo dzekunze, nepo heparin iri jekiseni remushonga unowanzo shandiswa muchipatara.
Coumadin kana heparin iri nani here?
Kutanga kwaHeparin kwekuita kunokurumidza kupfuura Coumadin asi kunofanirwa kuteverwa nekuramba kuchiputirwa kana majekiseni anowanzoitika. Naizvozvo, heparin inogona kungoshandiswa chete muchipatara. Coumadin inogona kutora mazuva akati wandei kuti ibudirire asi yakachengeteka kutorwa munzvimbo yekunze. Varwere paCoumadin vanofanirwa kuongororwa kuongororwa kweropa nguva dzese kuti vaone kuti INR yavo iri munzvimbo yakakodzera.
Ndinogona here kushandisa Coumadin kana heparin ndichiri nepamuviri?
Coumadin inodarika iyo placenta mune vakadzi vane nhumbu uye yakaratidzirwa kuve ine teratogenic mhedzisiro. Coumadin iri, nekudaro, inopesana nepamuviri kunze kwekunge murwere aine yeakanika yemoyo vharuvhu kana ari panjodzi yakanyanya yechiitiko chepromboembolic. Heparin inogona kupihwa panguva yekuzvitakura sezvo isingayambuke iyo placenta, zvisinei, vazhinji varapi vanosarudza yakaderera mamorekuru uremu heparin (LMWH) mukuzvitakura senge Lovenox (enoxaparin).
Ndinogona here kushandisa Coumadin kana heparin nedoro?
Iko hakuna kupesana kwekushandisa doro kune Coumadin kana heparin. Nekudaro, doro rinogona kukanganisa hepatic basa kune vamwe varwere, zvichikonzera kudiwa kwekutarisisa kweINR kana uchitora Coumadin.
Nderipi zita regeneral reHepparin?
Heparin izita rakajairika.
