Taw qhia
Ib qho peptide generated uas yog ib feem ntawm cov chav kawm ncaj thrombosis blocker yog tsim los ua bivalirudin. Cov tshuaj anticoagulant no ua haujlwm feem ntau kom tsis txhob muaj ntshav txhaws thiab mob ischemic thaum lub sijhawm ua haujlwm plawv thiab percutaneous coronary intervention (PCI). Hauv tsab ntawv blog no, peb yuav tshawb txog qhov xwm txheej ntawmBivalirudin, nws cov txheej txheem ntawm kev ua, kev ruaj ntseg profile, thiab qhov zoo dua lwm cov tshuaj tiv thaiv kab mob, tshwj xeeb yog heparin.
Bivalirudin txawv ntawm heparin li cas hauv nws txoj kev ua haujlwm?
Bivalirudin thiab heparin yog ob qho tib si tshuaj tiv thaiv coagulant siv los tiv thaiv cov ntshav txhaws thaum lub sijhawm ua haujlwm ntawm cov hlab plawv. Lawv cov tswv yim rau tus cwj pwm, txawm li cas los xij, sib txawv heev, uas muaj txiaj ntsig zoo rau lawv cov kev siv tshuaj, kev nyab xeeb, thiab kev ua haujlwm.
Heparin ua hauj lwm raws li ib tug upstream thrombin blocker los ntawm latching nws tus kheej mus rau antithrombin III, ib tug protein uas pom nyob rau hauv cov ntshav uas ib txwm suppresses cov txheej txheem coagulation, thiab nthuav cov kev cuam tshuam nws muaj. Tom qab ntawd, antithrombin III txwv cov txheej txheem ntawm cov ntshav txhaws los ntawm kev ua tsis taus ntawm cov coagulation proteins, xws li thrombin (factor IIa) thiab factor Xa. Qhov kev tsis ncaj ncees no, uas tso siab rau antithrombin III rau kev coj cwj pwm, tswj cov nyhuv heparin coagulation.
Ntawm qhov tod tes,bivalirudinyog ib qho tshwj xeeb fibrinogen blocker, implying tias nws hooks nruj nreem rau thrombin thiab tiv thaiv nws los ntawm activating. Synthetic 20-amino acid molecule bivalirudin imitates fibrinogen, uas yog cov organic precursor ntawm thrombin. Nws reversibly latches rau thrombin lub active qhov chaw thiab txwv tsis pub nws los ntawm splitting fibrinogen, uas yog lub hauv paus ntsiab lus ntawm cov ntshav txhaws, mus rau hauv fibrin. Tsis muaj teeb meem dab tsi yog qhov tseem ceeb ntawm txoj kev ua haujlwm (txoj hauv kev los yog sab hauv), Bivalirudin ntse inhibits txoj hauv kev kawg ntawm cov txheej txheem coagulation los ntawm kev sib tw thrombin.
Piv nrog rau heparin, bivalirudin txoj kev ua tam sim ntawd muaj ntau qhov zoo. Ua ntej, Bivalirudin muab cov lus teb ua kom pom tseeb dua cov tshuaj tiv thaiv coagulant piv rau heparin. Antithrombin III theem thoob plaws cov ntshav, muaj cov proteins heparin-binding, thiab qhov sib txawv ntawm cov tshuaj heparin tuaj yeem cuam tshuam rau kev ua haujlwm ntawm heparin. Anticoagulant kev ua ub no tuaj yeem loj hlob tsis tuaj yeem pom thiab tsis tau npaj los ntawm cov xwm txheej no, yuav tsum tau saib xyuas lub sijhawm thiab kho cov tshuaj. Ntawm qhov tod tes, yuav tsum tau saib xyuas tsawg dua vim qhov tsis hloov pauv ntau dua thiab xav tias yuav muaj cov lus teb anticoagulant los ntawm Bivalirudin tam sim ntawd fibrin blockage.
Thib ob, cov khoom tiv thaiv coagulant ntawm bivalirudin tuaj yeem rov qab sai sai tom qab txiav tawm vim nws lub neej ib nrab me dua li heparin. Bivalirudin ib nrab-lub neej yog kwv yees li 25 feeb, piv rau heparin ib nrab-lub neej ntawm 1-2 teev. Lub sijhawm luv luv ntawm kev ua haujlwm no yog qhov zoo tshwj xeeb hauv cov xwm txheej uas xav tau kev thim rov qab sai ntawm cov tshuaj tiv thaiv coagulation, xws li hauv qhov teeb meem los ntshav lossis xav tau kev phais sai.
Thib peb, Bivalirudin qhov ncaj qha thrombin inhibition tuaj yeem muab cov nyhuv anticoagulant zoo dua hauv qee qhov xwm txheej kho mob. Hauv kev teeb tsa ntawm PCI, piv txwv li, cov qib siab ntawm thrombin tsim los ntawm qhov chaw ntawm cov hlab ntsha tuaj yeem cuam tshuam heparin qhov tsis ncaj qha inhibitory nyhuv. Bivalirudin's ncaj qha thrombin inhibition tuaj yeem cuam tshuam qhov kev ua haujlwm hauv zos thrombin, uas tuaj yeem txo qhov kev pheej hmoo ntawm cov teeb meem ischemic.
Tsis tas li ntawd, Bivalirudin cov txheej txheem ntawm kev ua haujlwm tuaj yeem muab qhov zoo rau cov neeg mob uas muaj heparin-induced thrombocytopenia (HIT), ib qho kev tiv thaiv kab mob hnyav ntawm kev kho mob heparin. Hauv HIT, cov tshuaj tiv thaiv tiv thaiv heparin-platelet factor 4 complexes ua rau platelets, ua rau thrombocytopenia thiab thrombotic teeb meem.Bivalirudintsis cuam tshuam nrog cov tshuaj tiv thaiv no thiab tuaj yeem siv nyab xeeb los ua lwm yam tshuaj tiv thaiv coagulant hauv cov neeg mob uas muaj keeb kwm ntawm HIT.
Hauv cov ntsiab lus, Bivalirudin txawv ntawm heparin hauv nws cov txheej txheem ntawm kev ua haujlwm los ntawm kev cuam tshuam ncaj qha thrombin, tsis yog txhim kho cov haujlwm ntawm antithrombin III. Cov txheej txheem ncaj qha no muab cov lus teb rau cov tshuaj tiv thaiv coagulant ntau dua, lub sijhawm ua haujlwm luv dua, thiab muaj txiaj ntsig zoo hauv qee qhov xwm txheej kho mob, xws li PCI thiab HIT. Kev nkag siab txog qhov sib txawv no yog qhov tseem ceeb rau kev txhim kho kev siv cov tshuaj tiv thaiv coagulants hauv kev kho mob.
Puas yog Bivalirudin muaj kev nyab xeeb dua li cov tshuaj heparin rau cov neeg mob uas tau txais kev cuam tshuam los ntawm percutaneous coronary?
Kev tso stent lossis angioplasty nrog balloons yog ob txoj kev phais mob uas siv los kho cov kab mob coronary artery (CAD). PCI suav nrog kev nthuav dav thaiv lossis txwv cov phab ntsa hlab ntsha thiab rov pib ntshav. Txhawm rau tiv thaiv thrombosis thiab cov teeb meem ischemic thaum lub sijhawm PCI, yuav tsum muaj kev tiv thaiv coagulation. Heparin thiab bivalirudin yog ob hom tshuaj ntshav uas muaj txiaj ntsig zoo siv rau qhov laj thawj no. Tab sis tau muaj kev sib cav ntau thiab nug txog seb bivalirudin puas muaj kev phom sij tsawg dua li heparin thaum ua hauj lwm hauv kev teeb tsa ntawm PCI.
Bivalirudin thiab heparin tau raug soj ntsuam rau ob qho tib si kev nyab xeeb thiab kev ua tau zoo nyob rau hauv ntau yam kev tshawb fawb loj ua nrog PCI cov neeg mob. Bivalirudin tau dhau los ua qhov tsis zoo rau heparin nrog glycoprotein IIb / IIIa inhibitor (GPI) kom txo qis cov teeb meem ischemic, nrog rau kev poob qis ntau ntawm cov ntshav los ntshav, raws li REPLACE-2 sim, uas tau xyaum 6, 000 yam. Tshaj li 13 xyoos, 000 cov tib neeg uas muaj tus mob coronary syndrome tau koom nrog hauv ACUITY sim, uas tau tsim tias thaum bivalirudin los ntawm nws tus kheej muaj feem xyuam rau cov xwm txheej zoo sib xws, nws txo qis ntshav ntau thaum piv nrog heparin ntxiv rau GPI.
Qhov txo qis ntawm kev los ntshav nrog Bivalirudin piv rau heparin tau pom zoo nyob rau ntau qhov kev tshawb fawb. Qhov no yog qhov tseem ceeb tshwj xeeb, vim tias muaj teeb meem los ntshav tom qab PCI cuam tshuam nrog kev mob hnyav ntxiv, kev tuag, thiab nqi kho mob. Cov txheej txheem tom qab Bivalirudin qhov kev pheej hmoo los ntshav qis yog xav tias muaj feem cuam tshuam rau nws qhov ncaj qha thiab thim rov qab thrombin inhibition, uas tso cai rau kev tswj hwm ntau dua thiab kwv yees cov nyhuv anticoagulant piv rau heparin txoj haujlwm tsis ncaj thiab hloov pauv.
Ntxiv nrog rau nws qhov kev pom zoo los ntshav profile,Bivalirudinkuj tau txuam nrog txo qis ntawm heparin-induced thrombocytopenia (HIT) piv rau heparin. HIT yog ib qho teeb meem loj hauv kev tiv thaiv kab mob ntawm cov tshuaj heparin uas tuaj yeem ua rau thrombocytopenia thiab cov xwm txheej thrombotic. Los ntawm kev zam kom tsis txhob muaj cov tshuaj tiv thaiv kab mob sib kis nrog heparin, Bivalirudin muaj kev nyab xeeb dua rau cov neeg mob uas muaj keeb kwm ntawm HIT lossis cov neeg muaj kev pheej hmoo siab los tsim qhov teeb meem no.
Txawm li cas los xij, nws yog ib qho tseem ceeb kom nco ntsoov tias qhov zoo ntawm kev nyab xeeb ntawm Bivalirudin piv rau heparin hauv PCI tau raug nug los ntawm qee qhov kev tshawb fawb tsis ntev los no. Kev sim HEAT-PPCI, uas tau tso npe ntau dua 1,800 tus neeg mob nrog ST-segment nce myocardial infarction (STEMI) tab tom ua thawj PCI, pom tias heparin cuam tshuam nrog txo qis ntawm cov xwm txheej mob plawv loj thiab stent thrombosis piv rau Bivalirudin, tsis muaj qhov sib txawv loj hauv los ntshav nyuaj. Cov kev tshawb pom no qhia tias qhov kev xaiv anticoagulant zoo tshaj plaws hauv PCI tuaj yeem nyob ntawm cov neeg mob tshwj xeeb thiab cov ntsiab lus kho mob.
Tsis tas li ntawd, tus nqi-zoo ntawm Bivalirudin piv rau heparin hauv PCI tau yog ib qho teeb meem ntawm kev sib cav. Bivalirudin tseem kim dua li heparin, thiab qee qhov kev tshawb fawb tau qhia tias nws niaj hnub siv yuav tsis raug cai los ntawm kev saib xyuas kev noj qab haus huv, tshwj xeeb tshaj yog rau cov neeg mob qis dua lossis cov tsis muaj keeb kwm ntawm HIT.
Hauv kev xyaum kho mob, kev txiav txim siab siv Bivalirudin lossis heparin hauv PCI yuav tsum ua raws li kev saib xyuas zoo ntawm tus neeg mob yam xwm txheej, xws li kev pheej hmoo ntawm ischemic thiab los ntshav cov teeb meem, muaj kev sib txuam, thiab cov ntsiab lus tshwj xeeb hauv kev kho mob. Hauv cov neeg mob uas muaj kev pheej hmoo los ntshav los yog keeb kwm ntawm HIT, Bivalirudin tuaj yeem muab lwm txoj kev nyab xeeb rau heparin. Txawm li cas los xij, hauv cov neeg mob qis dua lossis cov neeg muaj STEMI, heparin yuav nyiam vim nws cov nqi qis dua thiab muaj peev xwm ua tau zoo dua.
Hauv kev xaus, thaum Bivalirudin tau cuam tshuam nrog kev pheej hmoo los ntshav thiab HIT piv rau heparin hauv PCI, cov lus nug ntawm nws txoj kev nyab xeeb thiab kev ua tau zoo tag nrho tseem yog lub ntsiab lus ntawm kev tshawb fawb thiab kev sib cav. Qhov zoo tshaj plaws anticoagulant xaiv hauv PCI yuav tsum yog tus kheej raws li tus neeg mob cov yam ntxwv thiab kev txiav txim hauv chaw kho mob, ntsuas qhov txaus ntshai thiab cov txiaj ntsig ntawm txhua qhov kev xaiv. Raws li cov pov thawj tshiab tshwm sim, nws yuav yog ib qho tseem ceeb rau cov kws kho mob kom nyob twj ywm tshiab ntawm kev hloov pauv ntawm cov tswv yim anticoagulation hauv PCI los xyuas kom meej qhov ua tau zoo tshaj plaws rau lawv cov neeg mob.
Dab tsi yog qhov zoo ntawm kev siv Bivalirudin hauv kev phais plawv?
Kev ua haujlwm zoo thromboembolism yog qhov tsim nyog rau kev ua haujlwm ntawm lub plawv, suav nrog kev hla kev grafting, tseem hu ua CABG, thiab hloov pauv los yog kho lub valve, txhawm rau kom tsis txhob muaj thrombosis thiab xa cov txiaj ntsig kev phais zoo tshaj plaws. Heparin tau ntev tau xaiv los ua ib qho tshuaj tiv thaiv kab mob thaum lub sijhawm ua haujlwm plawv vim nws pib sai sai, yooj yim hauv kev soj ntsuam, thiab kev hloov pauv ntawm protamine. Txawm li cas los xij, kev siv Bivalirudin hauv kev phais plawv tau txais kev saib xyuas ntau ntxiv nyob rau xyoo tas los no, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas muaj keeb kwm ntawm heparin-induced thrombocytopenia (HIT) los yog cov neeg muaj kev pheej hmoo siab los ntshav.
Qhov zoo tshaj plaws coagulation nyob rau hauv cov neeg mob nrog ib tug yav dhau los rov ntawm HIT tsuas yog ib qho ntawm qhov zoo tshaj plaws ntawm kev ua hauj lwm bivalirudin nyob rau hauv lub plawv ua hauj lwm. Heparin txoj kev kho lub hauv paus tseem ceeb ntawm kev tiv thaiv kab mob tsis zoo, hu ua thrombocytopenia, tuaj yeem ua rau muaj teeb meem thrombotic xws li cov hlab ntsha thrombosis, ntsws embolism, thiab tob vein embolism. Kev siv Heparin thaum lub sijhawm ua haujlwm ntawm lub plawv tuaj yeem ua rau muaj qhov tshwm sim ntawm lub cev tiv thaiv kab mob hauv cov tib neeg uas muaj keeb kwm ntawm HIT, uas yuav muaj qhov tshwm sim loj. Txij li thaum bivalirudin yog ib qho tshwj xeeb thrombin blocker thiab tsis cuam tshuam nrog HIT antigens, nws raug tso cai siv rau hauv cov neeg no ua lwm yam coagulant.
BivalirudinQhov kev ua tau zoo thiab kev ruaj ntseg hauv lub plawv ua haujlwm rau cov tib neeg uas muaj keeb kwm ntawm HIT tau ua pov thawj los ntawm ntau qhov kev xeem. Hauv kev tshuaj xyuas rov qab ntawm ntau dua 100 tus neeg mob nrog HIT uas tau txais kev phais mob plawv nrog Bivalirudin anticoagulation, qhov tshwm sim ntawm cov teeb meem thrombotic thiab los ntshav loj tsawg, tsis muaj qhov tshwm sim ntawm HIT. Cov kev tshawb pom no qhia tias Bivalirudin tuaj yeem muab cov tshuaj tiv thaiv zoo thaum txo qis kev pheej hmoo ntawm kev tiv thaiv kab mob hauv cov neeg mob uas muaj kev pheej hmoo siab.
Lwm qhov zoo ntawm Bivalirudin hauv kev phais plawv yog nws lub peev xwm los txo cov ntshav tsis zoo piv rau heparin. Los ntshav yog ib qho teeb meem loj heev ntawm kev phais plawv, cuam tshuam nrog kev mob hnyav ntxiv, kev tuag, thiab nqi kho mob. Qhov ncaj qha thiab thim rov qab thrombin inhibition muab los ntawm Bivalirudin tuaj yeem ua rau muaj kev tswj xyuas ntau dua thiab muaj peev xwm tiv thaiv cov nyhuv anticoagulant piv rau heparin, txo qhov kev pheej hmoo los ntshav ntau dhau.
Ntau qhov kev tshawb fawb tau sib piv cov txiaj ntsig los ntshav ntawm Bivalirudin piv rau heparin hauv cov neeg mob phais plawv. Hauv kev sim tshuaj ntsuam xyuas randomized ntawm ntau dua 100 tus neeg mob uas tau txais CABG, Bivalirudin tau cuam tshuam nrog txo qis ntshav thiab cov kev xav tau hloov pauv piv rau heparin. Lwm txoj kev tshawb fawb ntawm ntau dua 200 tus neeg mob uas tau txais kev phais lub valve pom tias Bivalirudin tau cuam tshuam nrog kev txo cov ntshav thiab kev hloov pauv piv rau heparin, tsis muaj qhov sib txawv ntawm cov teeb meem thrombotic.
Lub peev xwm los ntshav zoo ntawm Bivalirudin hauv kev phais mob plawv yuav muaj feem cuam tshuam tshwj xeeb rau cov neeg mob uas muaj kev pheej hmoo los ntshav, xws li cov raum tsis ua haujlwm, muaj hnub nyoog siab, lossis kev kho tshuaj antiplatelet sib xyaw. Los ntawm kev txo qhov kev pheej hmoo los ntshav ntau dhau, Bivalirudin tuaj yeem txhim kho qhov tshwm sim ntawm kev phais thiab txo qhov kev xav tau ntawm cov khoom siv ntshav, uas ua rau lawv tus kheej txaus ntshai thiab cov nqi.
Ntxiv rau nws cov txiaj ntsig hauv HIT thiab txo cov ntshav,Bivalirudinkuj tseem tuaj yeem muab cov txiaj ntsig zoo ntawm kev saib xyuas thiab thim rov qab piv rau heparin. Heparin's anticoagulant effect feem ntau yog saib xyuas siv lub sijhawm ua kom ntshav txhaws (ACT), uas tuaj yeem cuam tshuam los ntawm ntau yam xws li hemodilution, hypothermia, thiab platelet tsis ua haujlwm. Hauv qhov sib piv, Bivalirudin's anticoagulant nyhuv yog qhov xav tau ntau dua thiab cuam tshuam tsawg dua los ntawm cov kev hloov pauv no, muaj peev xwm ua kom yooj yim saib xyuas thaum phais.
Tsis tas li ntawd, thaum heparin's anticoagulant nyhuv tuaj yeem thim rov qab nrog protamine, tus neeg sawv cev thim rov qab no cuam tshuam nrog nws tus kheej txaus ntshai, suav nrog hypotension, bradycardia, thiab anaphylaxis. Bivalirudin luv luv ib nrab-lub neej ntawm kwv yees li 25 feeb tso cai rau kev thim rov qab sai ntawm nws cov nyhuv anticoagulant tom qab txiav tawm, tsis tas yuav tsum muaj tus neeg sawv cev thim rov qab. Qhov no tuaj yeem ua tau zoo nyob rau hauv cov xwm txheej uas xav tau kev thim rov qab sai ntawm anticoagulation, xws li nyob rau hauv qhov teeb meem los ntshav los yog xav tau kev tshawb nrhiav ceev.
Txawm li cas los xij, nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias kev siv Bivalirudin hauv kev phais plawv kuj muaj qee qhov kev txwv thiab cov nyom. Bivalirudin tseem kim dua li heparin, thiab nws cov txiaj ntsig zoo hauv kev phais plawv niaj hnub tseem yog lub ntsiab lus ntawm kev sib cav. Tsis tas li ntawd, kev siv tshuaj zoo tshaj plaws thiab kev saib xyuas cov tswv yim rau Bivalirudin hauv kev phais plawv tseem raug kho kom zoo, thiab yuav tsum muaj kev tshawb fawb ntxiv los tsim cov txheej txheem thiab cov txheej txheem.
Hauv kev kho mob, kev txiav txim siab siv Bivalirudin hauv kev phais mob plawv yuav tsum tau ua raws li kev saib xyuas kom zoo ntawm tus neeg mob yam tseem ceeb, xws li muaj HIT, kev pheej hmoo ntawm cov teeb meem los ntshav, thiab cov ntsiab lus ntawm kev phais tshwj xeeb. Hauv cov neeg mob uas muaj keeb kwm ntawm HIT lossis cov neeg muaj kev pheej hmoo los ntshav, Bivalirudin tuaj yeem muab cov txiaj ntsig tseem ceeb tshaj heparin. Txawm li cas los xij, hauv cov neeg mob uas muaj kev pheej hmoo qis lossis cov uas tsis muaj kev cuam tshuam rau heparin, kev siv Bivalirudin niaj hnub yuav tsis raug lees paub los ntawm qhov kev xav tau zoo.
Hauv kev xaus,Bivalirudinmuaj ntau qhov txiaj ntsig zoo hauv kev phais plawv, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas muaj keeb kwm ntawm HIT lossis cov neeg muaj kev pheej hmoo siab los ntshav. Nws ncaj qha thrombin inhibition, cov nyhuv anticoagulant tuaj yeem ua tau, thiab ib nrab-lub neej luv ua rau nws zoo dua lwm txoj rau heparin hauv cov ntsiab lus no. Txawm li cas los xij, kev siv Bivalirudin zoo tshaj plaws hauv kev phais mob plawv yuav tsum muaj txoj hauv kev ntawm tus kheej, ntsuas qhov txaus ntshai thiab txiaj ntsig rau txhua tus neeg mob. Raws li kev tshawb fawb ntxiv, nws yuav yog ib qho tseem ceeb rau cov kws kho mob kom nyob twj ywm tshiab ntawm lub luag haujlwm hloov pauv ntawm Bivalirudin hauv kev phais plawv thiab koom nrog cov kev paub no rau hauv lawv qhov kev txiav txim siab kho mob kom ntseeg tau tias qhov ua tau zoo tshaj plaws rau lawv cov neeg mob.
Cov ntaub ntawv
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