Dab tsi yog Kev Kho Mob ntawm Bivalirudin?

Vim nws tshwj xeeb pharmacological zog thiab restorative cuam tshuam,bivalirudin, ib qho thrombin inhibitor tam sim ntawd, tau txais kev txiav txim siab zoo hauv kev kho mob plawv. Raws li ib tug fabricated peptide, nws siv nws anticoagulant influences los ntawm kom meej meej confining rau thiab thwarting thrombin, ib tug yooj yim hluavtaws nyob rau hauv lub coagulation dej nyab. Bivalirudin qhov kev cuam tshuam sib txawv yuav raug tshuaj xyuas hauv qhov kev nkag blog no, nrog rau qhov tseem ceeb ntawm nws txoj hauv kev kho mob heparin-prompted thrombocytopenia (HIT), txo qis kev tsis meej pem thaum lub sij hawm kho mob plawv, thiab ua rau muaj kev ntxhov siab thaum lub sij hawm percutaneous coronary mediation (PCI).

Percutaneous coronary mediation (PCI) yog ib qho kev kho mob obtrusive rau cov kab mob coronary corridor uas suav nrog kev teeb tsa lub stent lossis ua haujlwm inflatable angioplasty kom rov tsim cov ntshav hauv cov kev txwv lossis cuam tshuam cov hlab ntsha. Kev cuam tshuam percutaneous coronary intervention (PCI) tuaj yeem pib cov coagulation overflow, uas tuaj yeem ua rau apoplexy thiab lwm yam teeb meem ischemic. Qhov no yog vim cov ntshav xa mus rau qhov chaw tsis paub thiab cov hlab ntsha phab ntsa raug puas tsuaj. Vim tias muaj txiaj ntsig zoo anticoagulation yog qhov tsim nyog los tiv thaiv cov teeb meem no, nws tau tshwm sim los ua lwm txoj hauv kev rau heparin.

Tiv thaiv cov teeb meem circulatory yog Bivalirudin thawj cov nyhuv tsis tu ncua thaum lub sij hawm PCI ua tsaug rau nws tam sim ntawd thiab unambiguous thrombin block. Thrombin yog ib qho tseem ceeb ntawm cov dej nyab coagulation. Nws koom nrog hauv kev txiav txim siab thiab ntau yam ntawm platelets nrog rau kev hloov pauv ntawm fibrinogen rau hauv fibrin. Cov khoom no txo ​​cov platelet-interceded circulatory teeb meem thiab txoj kev npaj ntawm fibrin pawg los ntawm kom meej meej txwv mus rau qhov chaw tshwj xeeb ntawm thrombin thiab thaiv nws enzymatic kev ua si.

Ob peb qhov kev txhim kho loj heev pib qhov chaw kho mob tau pom qhov kev txiav txim zoo ntawm Bivalirudin hauv kev cuam tshuam cov kab mob thrombotic nyuaj thaum PCI. Nyob rau hauv Supplant 2 ua ntej, uas suav nrog ntau dua 6, 000 cov neeg mob, nws ua tau zoo dua heparin thiab glycoprotein IIb / IIIa inhibitor (GPI) hauv kev tiv thaiv cov xwm txheej ischemic xws li tuag, myocardial localized necrosis, thiab nias revascularization. Hauv kev sim Keenness, uas suav nrog ntau dua 13,000 cov neeg mob uas muaj mob hnyav, nws tau pom tias muaj feem cuam tshuam nrog cov xwm txheej ischemic uas piv rau cov heparin thiab GPI tag nrho.

Bivalirudin rov qab cuam tshuam qhov cuam tshuam ntawm PCI circulatory nyuaj los ntawm kev ua tau zoo ntawm nws cov khoom siv tshuaj muaj txiaj ntsig zoo. Nyob rau hauv sib piv rau heparin, uas yuav tsum tau antithrombin III raws li ib tug cofactor thiab txwv thrombin nyob rau hauv ib tug convoluted yam, nws khi ncaj qha rau thrombin thiab tiv thaiv nws cov kev ua. Vim hais tias ntawm no ncaj qha mechanism ntawm kev txiav txim, cov nyhuv anticoagulant yog ntau kwv yees thiab zoo ib yam, thiab cov lus teb txawv tsawg ntawm cov neeg mob.

Ntxiv mus, Bivalirudin's anticoagulant cuam tshuam tuaj yeem hloov pauv sai sai tom qab nws 25-feeb ib nrab-lub neej tau dhau mus. Qhov kev ua tau zoo no yog qhov tshwj xeeb tshaj yog thaum muaj kev cuam tshuam rau percutaneous coronary intervention (PCI), thaum nws yog ib qho tseem ceeb kom tswj tau cov dej ntws tawm thiab hloov cov tshuaj tua kab mob sai sai. Tom qab ntawd ib zaug ntxiv, heparin muaj ntau dua ib nrab-lub neej thiab yuav tsum muaj kev sib raug zoo ntawm protamine rau inversion, uas tuaj yeem txuas nrog nws tus kheej cov kev cuam tshuam tsis zoo.

Txawm hais tias nws cov kev cuam tshuam los ntawm cov tshuaj tiv thaiv kab mob, nws tau tshwm sim kom yooj yim cov kev mob tshwm sim, uas tuaj yeem tsim nws cov txiaj ntsig zoo PCI. Nws pom tau hais tias thrombin pib ob peb txoj hauv kev sib txuas, zoo li tsim cov cytokines thiab qhov nce ntawm daim ntawv cog lus rau cov hlwb endothelial. Los ntawm kev tswj cov thrombin, nws tuaj yeem tau txais cov kev cuam tshuam cuam tshuam thiab txo qis cov thawj koom ruam tom qab PCI loads, piv txwv li, restenosis thiab atherosclerosis txhim kho.

Bivalirudin qhov muaj txiaj ntsig zoo rau kev cuam tshuam txog kev cuam tshuam txog kev cuam tshuam ntawm cov hlab ntshav thaum lub sijhawm PCI tau tso siab tau pom nyob rau hauv kev kho mob primer thiab lees paub kev xyaum. Nws tau pom zoo los ntawm heparin hauv American College of Cardiology Foundation / American Heart Association (ACCF/AHA) PCI cov lus qhia rau cov neeg mob uas muaj kev pheej hmoo siab rau depleting disarrays. Raws li European Society of Cardiology (ESC) cov lus qhia rau kev tswj cov xwm txheej txawv txav, cov khoom kuj tseem raug txiav txim siab rau cov neeg mob uas pheej hmoo PCI.

Txawm li cas los xij, nws tseem ceeb heev uas yuav tsum nco ntsoov tias kev siv cov khoom lag luam hauv txhua txoj kev PCI tseem tab tom thov kom ua pov thawj tsis raug.Bivalirudinthiab heparin tsis zoo sib xws kom deb li deb li ischemic lossis depleting disarrays hauv lub hwj chim PPCI qhov tseem ceeb, uas suav nrog ntau dua 1,800 tus neeg mob uas muaj ST-thooj nce myocardial txwv rot (STEMI) mus los ntawm kev sib haum xeeb percutaneous coronary (PCI). Qhov no qhia tau hais tias qhov kev kho mob ntawm cov khoom yuav tsis muaj zog rau thawj zaug percutaneous coronary intervention (PCI) rau STEMI, qhov uas muaj kev pheej hmoo ntawm cov teeb meem circulatory yog tshwj xeeb tshaj yog siab thiab muaj zog antiplatelet agents nquag siv.

Yeej, Bivalirudin qhov cuam tshuam tsis tu ncua ntawm kev cuam tshuam txog kev cuam tshuam ntawm cov teeb meem hauv lub cev thaum lub sijhawm PCI yog cuam tshuam los ntawm nws qhov chaw nyob ze thiab tsis paub meej thrombin tswj. Vim nws qhov qub thiab zoo ib yam ntawm cov tshuaj tiv thaiv coagulant, ib nrab ntawm lub neej luv luv, thiab muaj peev xwm ua kom muaj zog, bivalirudin tau tshwm sim los ua ib qho kev xaiv yooj yim dua li heparin ntawm no. Kev xaiv seb puas yuav noj cov khoom rau percutaneous coronary intervention (PCI) yuav tsum tau ua nyob rau hauv ib tug neeg lub hauv paus coj mus rau hauv tus account tus yam ntxwv ntawm tus neeg mob nrog rau kev soj ntsuam kev txiav txim nyob rau hauv thiaj li yuav soj ntsuam cov kev pab cuam thiab txaus ntshai ntawm no anticoagulant system.

Txhawm rau kom tsis txhob muaj thrombosis thiab ua tiav cov txiaj ntsig tau zoo tshaj plaws los ntawm kev phais mob plawv, xws li cov hlab ntsha ntawm cov hlab ntsha bypass grafting (CABG) thiab lub valve hloov lossis kho, yuav tsum muaj kev tiv thaiv zoo. Txawm li cas los xij, muaj kev sib txuas ntawm kev siv cov tshuaj anticoagulants thaum lub sij hawm phais plawv thiab muaj kev pheej hmoo los ntshav ntau ntxiv. Cov teeb meem no tuaj yeem tsim kev hloov pauv, xav tau nyob hauv tsev kho mob ntev, thiab muaj kev cuam tshuam tsis zoo rau cov neeg mob tau txais txiaj ntsig. Raws li txoj cai, heparin tau ua cov tshuaj tiv thaiv ntawm kev txiav txim siab hauv cov txheej txheem kho mob plawv, tab sis kev siv Bivalirudin tau txais kev txaus siab raws li txoj kev xav kom txo qis cov dej ntws tawm.

Vim nws cov khoom tshwj xeeb pharmacological, nws muaj cov txiaj ntsig kho mob ntawm kev txo qis kev phais mob ntsig txog los ntshav. Hauv kev sib piv rau heparin, nws muaj qhov ua tau zoo dua thiab muaj txiaj ntsig anticoagulant vim tias nws yog ib qho ncaj qha thrombin inhibitor. Qhov no yog qhov tseem ceeb tshwj xeeb tshaj yog nyob rau hauv kev teeb tsa ntawm cov txheej txheem kho mob plawv, qhov twg cov txheej txheem ntawm coagulation overflow thiab kev siv cov ntsiab lus coagulation tuaj yeem ua rau muaj kev hloov pauv mus rau heparin thiab nthuav dav kev twv txiaj.

Bivalirudin cov txiaj ntsig los ntshav hauv cov neeg mob phais plawv tau muab piv rau cov heparin hauv ntau cov kev tshawb fawb. Nws tau pom tias txo qis 24-teev lub hauv siab lub raj dej thiab cov kev xav tau hloov pauv thaum piv rau heparin nrog protamine reversal nyob rau hauv EVOLUTION-ON sim, uas suav nrog cov neeg mob hauv lub twj tso kua mis CABG. Nws outperformed heparin nyob rau hauv cov nqe lus ntawm postoperative ntshav poob thiab kev hloov pauv yuav tsum tau nyob rau hauv cov neeg mob nyob rau hauv lub twj tso kua mis CABG, raws li tau pom los ntawm ib tug meta-kev soj ntsuam ntawm randomized tswj kev sim.

Kev kho qhov cuam tshuam ntawm cov khoom hauv kev txo qis cov dej ntws tawm hauv cov txheej txheem kho mob plawv yuav raug sau tseg rau ob peb lub ntsiab lus. Ua ntej, Bivalirudin qhov ncaj qha thrombin inhibition ua rau nws cov nyhuv anticoagulant ruaj khov thiab kwv yees, txo cov neeg mob cov lus teb hloov pauv. Qhov no tuaj yeem txo qis qhov kev twv txiaj ntawm kev mus deb dhau thiab dhau ntawm cov tshuaj tiv thaiv coagulation sab saum toj, uas tuaj yeem ntxiv rau kev tuag ntxiv.

Qhov thib ob, nws muaj luv luv ib nrab-lub neej nyob ib ncig ntawm 25 feeb-uas ua rau nws rov qab sai sai rau nws cov nyhuv anticoagulant thaum txiav tawm. Hauv kev phais mob plawv, qhov uas muaj peev xwm tswj tau cov ntshav sai sai thiab thim rov qab anticoagulation yog qhov tseem ceeb, cov cuab yeej no tseem ceeb tshwj xeeb. Hauv qhov sib piv, qhov thim rov qab ntawm heparin xav tau kev tswj hwm ntawm protamine, uas muaj peev xwm cuam tshuam nrog nws tus kheej tsis zoo xws li hypotension thiab kev tsis haum tshuaj.

Qhov thib peb, nws tsis tshua muaj kev cuam tshuam rau platelet muaj peev xwm sib piv nrog heparin. Heparin muaj peev xwm khi rau thiab qhib cov platelets, uas tuaj yeem ua rau platelet sib sau ua ke thiab ua rau muaj kev pheej hmoo los ntshav.BivalirudinNtawm qhov tod tes, muaj qhov pheej hmoo los ntshav qis dua vim tias nws tsis cuam tshuam ntau npaum li platelets.

Txawm li cas los xij, nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias tsis yog txhua tus neeg pom zoo tias cov khoom muaj txiaj ntsig zoo rau kev txo cov ntshav los ntshav tom qab kev phais mob plawv. Qee qhov kev ntsuam xyuas tau tsis saib xyuas kom pom qhov sib txawv loj hauv cov txiaj ntsig ntawm cov khoom thiab heparin. Bivalirudin thiab heparin nrog protamine reversal muaj qhov tshwm sim los ntshav zoo sib xws hauv kev sim CHOOSE-ON, uas suav nrog cov neeg mob phais plawv nrog keeb kwm ntawm heparin-induced thrombocytopenia (HIT).

Tsis tas li ntawd, tus nqi siv tau ntawm niaj hnub nws siv hauv cov txheej txheem kho mob plawv tseem yog ib qho lus nug ntawm kev sib tham. Nws yog tag nrho cov nqi ntau dua li heparin, thiab cov txiaj ntsig me me kom deb li deb tau txo qis thiab cov txiaj ntsig ntawm tus neeg mob yuav tsis raug cai siv nws cov qauv hauv txhua txoj kev kho mob plawv.

Hauv kev xaus, Nws cov thrombin inhibition ncaj qha, cov nyhuv anticoagulant tuaj yeem, luv ib nrab ntawm lub neej, thiab kev cuam tshuam qis ntawm platelet muaj nuj nqi tshaj li heparin yog txhua yam uas ua rau nws cov txiaj ntsig kho mob hauv kev txo qis los ntshav cov teeb meem thaum phais plawv. Txawm hais tias qhov tseeb tias Nws tau pom tias txo qis los ntshav thiab qhov xav tau ntawm kev siv ntshav hauv ntau cov kev tshawb fawb, kev siv cov tshuaj tiv thaiv kab mob no tsis tu ncua hauv kev phais plawv tseem muaj teeb meem vim yog cov nqi thiab cov pov thawj tsis sib haum. Tus neeg mob txoj kev pheej hmoo ntawm cov teeb meem los ntshav thiab muaj qhov tshwm sim ntawm heparin-induced thrombocytopenia yuav tsum txhua tus ua lub luag haujlwm hauv kev txiav txim siab seb puas yuav siv cov khoom no thaum lub sij hawm phais plawv.

Ib qho kev nyab xeeb kev sib haum xeeb loj ntawm kev kho mob heparin hu ua heparin-incited thrombocytopenia (HIT) tuaj yeem ua tiav cov hlab ntsha tsis txaus ntseeg thiab thrombocytopenia. Antibodies tiv thaiv heparin-platelet factor 4 (PF4) cov tsev raug xa tawm thaum cov neeg mob HIT tau qhia rau heparin, impelling platelets thiab propelling hlab ntsha tawg. Txhawm rau kom nyob deb ntawm thrombotic entanglements, lub koom haum ntawm HIT yuav tsum tau ncua luv luv ntawm heparin thiab pib ntawm kev txiav txim siab anticoagulation. Cov khoom lag luam tau tsim nws tus kheej ua qhov kev nyab xeeb thiab muaj txiaj ntsig kev kho HIT.

Bivalirudinsuav tias yog ib feem hauv HIT kev kho mob vim tias nws tam sim ntawd thrombin hindrance thiab tsis muaj kev sib tshuam nrog HIT cov tshuaj tiv thaiv. Hloov chaw ntawm heparin, uas yuav tsum muaj antithrombin III rau nws cov nyhuv anticoagulant thiab tuaj yeem tsim cov tsev nrog PF4 uas ua rau muaj kev nyab xeeb cov tshuaj tiv thaiv hauv HIT, cov khoom tsuas yog khi rau thiab txwv tsis pub thrombin, muab cov nyhuv anticoagulant uas tsis tau txuas nrog cov txheej txheem tiv thaiv. Cov txheej txheem ntawm kev ua ub no, uas txwv tsis pub muaj kev nyab xeeb cuam tshuam cov txheej txheem thrombotic los ntawm kev ua haujlwm, ua rau nws ua tau rau cov khoom kom muaj txiaj ntsig cuam tshuam rau HIT cov neeg mob.

Ntau qhov kev kuaj mob tau pom tias cov khoom tuaj yeem siv los kho HIT. Kev tshuaj xyuas ntawm 451 cov neeg mob uas muaj kev xav lossis lees paub HIT tau pom tias nws muaj feem cuam tshuam nrog qhov tsawg zaus ntawm thrombotic zaus (2.2%) thiab kev nce siab ntawm platelet recuperation (92.5%). Kev npaj, qhib-npe kev tshawb xyuas ntawm 52 cov neeg mob uas tau lees paub HIT uas yuav tsum tau muaj kev tiv thaiv kab mob sib txawv, suav nrog cov txheej txheem kho mob plawv thiab percutaneous coronary mediation (PCI), pom tias nws tau ua tiav kev tiv thaiv cov teeb meem thrombotic, tsis muaj qhov xwm txheej tshiab lossis rov ua dua apoplexy thaum lub sijhawm. lub sij hawm kho mob.

Bivalirudin's restorative teebmeem nyob rau hauv kev kho mob ntawm HIT yog ntxiv kev txhawb nqa los ntawm nws cov zoo pharmacokinetic profile. Cov tshuaj tiv thaiv coagulant tau hloov tam sim ntawd los ntawm kev tso tseg, uas muaj luv luv ib nrab-muaj nyob ntawm kwv yees li 25 feeb. Vim tias cov khoom lag luam cov nyhuv anticoagulant tuaj yeem thim rov qab sai sai yam tsis tas yuav tsum muaj cov tshuaj tua kab mob tshwj xeeb, cov cuab yeej no tshwj xeeb tshaj yog muaj txiaj ntsig zoo rau cov xwm txheej uas yuav tsum tau muaj kev phais mob sai lossis cov txheej txheem invasive.

Tsis tas li ntawd, thaum sib txawv los ntawm lwm yam uas tsis yog-heparin anticoagulants zoo li fondaparinux lossis argatroban, nws tau pom tias muaj kev cia siab rau cov tshuaj tiv thaiv kab mob hauv HIT cov neeg mob uas muaj ntau yam tsawg dua li qhov xav tau. Qhov kev sib raug zoo no ua haujlwm ntawm kev kuaj xyuas thiab kev hloov pauv rau cov neeg mob uas muaj HIT.

Cov khoom raug pom zoo raws li kev xaiv uas tsis yog-heparin anticoagulant rau kev kho mob ntawm HIT tshwj xeeb nrog cov teeb meem ntawm cov hlab ntshav hauv 2018 American Culture of Hematology (Trash) cov cai rau lub koom haum ntawm venous thromboembolism. Nws kuj tseem yuav pom zoo li hauv cov neeg mob uas muaj lub hauv paus tsim los ntawm HIT uas xav tau kev tiv thaiv kev ua haujlwm ntawm lub plawv lossis vascular, raws li cov qauv.

Txawm li cas los xij, nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias kev siv Bivalirudin hauv kev kho HIT muaj qee qhov tsis zoo. Nws tus nqi siab dua tuaj yeem txwv nws txoj kev siv dav dav, tshwj xeeb tshaj yog nyob rau hauv cov chaw uas muaj peev txheej tsawg, piv rau lwm yam tsis-heparin anticoagulants. Nyob rau hauv cov xwm txheej uas ceev rov qab ntawm anticoagulation yog ib qho tseem ceeb, piv txwv li, nyob rau hauv qhov teeb meem ntawm outrageous demise, lub shortage ntawm ib tug tshwj xeeb counteractant rau nws kuj yog vim li cas rau kev txhawj xeeb.

Txhua yam uas tau txiav txim siab, cov khoom lag luam muaj zog tiv thaiv coagulation yam tsis muaj qhov cuam tshuam nrog HIT cov tshuaj tiv thaiv, ua rau nws yog ib qho tseem ceeb ntawm cov kws kho mob hauv kev kho HIT. Vim nws luv luv ib nrab-lub neej, unsurprising anticoagulant nyhuv, thiab tam sim ntawd thrombin restraint, nws yog ib tug txaus siab xaiv rau kev kho mob nyuaj no. Txawm hais tias qhov tseeb hais tias tus nqi txiav txim siab thiab tsis muaj ib tus kws tshaj lij inversion tshwj xeeb tuaj yeem txwv nws daim ntawv thov hauv qee qhov xwm txheej, cov pov thawj kho mob thiab cov lus qhia txhawb nqa kev siv Bivalirudin hauv HIT. Kev ntsuas qhov tob ntawm tus neeg mob qhov xwm txheej, cov peev txheej muaj, thiab cov txheej txheem hauv tsev yuav tsum qhia txog kev xaiv cov khoom rau kev kho HIT.

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