Ke hopohopo nei ʻoe e pili ana i nā ʻūpā koko? Ke hopohopo nei paha ʻoe e pili ana i ka loaʻa ʻana o ka hōʻeha puʻuwai a i ʻole ka hahau. No ka poʻe i ka pilikia, kuhikuhi nā kauka i kahi ʻano lāʻau i ʻike ʻia he "mea hoʻomāmā koko." No laila i kēia lā e kamaʻilio mākou e pili ana i kahi papa lāʻau hou, akā he mea nui loa. ʻO ia nā Direct Thrombin Inhibitors.
I ka ʻōlelo maʻalahi, he aha kēia mau mea hoʻopale Thrombin pololei?
ʻO kēia nā mea a mākou e kapa nei he mau lāʻau hoʻomāmā koko, a i ʻole nā mea pale koko ma nā ʻōlelo lapaʻau. ʻO kā lākou hana ka hoʻōki ʻana i ke kūkulu ʻia ʻana o nā ʻōpū koko i loko o ke kino. E noʻonoʻo wale, make ka hapa nui o ka poʻe ma ka honua i ka maʻi puʻuwai. No laila, he mea kōkua nui kēia mau ʻano lāʻau i ka pale ʻana i nā ʻōpū koko mai ka pani ʻana i nā kīʻaha koko e hoʻolako ana i nā ʻōkana koʻikoʻi e like me ka puʻuwai a me ka lolo.
ʻOiai i ka wā ma mua, ua hana ʻia kēia mau lāʻau lapaʻau me ka hoʻohana ʻana i nā mea like me ka protein i loaʻa i loko o ka lawai o nā leeches, hoʻohana ʻia nā lāʻau lapaʻau hou i hana ʻia i loko o nā keʻena hoʻokolohua.
He aha nā kūlana e hoʻohana ʻia ai kēia lāʻau lapaʻau?
Paipai nā kauka i kēia ʻano lāʻau lapaʻau, i kapa ʻia ʻo direct thrombin inhibitors, no ka pale ʻana a me ka kaohi ʻana i nā kūlana he nui. E nānā kākou i kahi papa e like me kēia e maʻalahi ai ka hoʻomaopopo ʻana i kēia ʻike.
| Kūlana | He wehewehe maʻalahi |
|---|---|
| ʻO ka maʻi coronary koʻikoʻi | Ka emi koke ʻana a i ʻole ke kū ʻana o ke kahe o ke koko ma muli o ke ālai ʻia ʻana o kahi aa koko e lawe ana i ke koko i ka puʻuwai. |
| ʻO ka Thrombocytopenia i hoʻoulu ʻia e Heparin (HIT) | He kūlana paʻakikī kahi e hoʻemi ai ka heparin hoʻokahe koko i ka nui o nā platelets, a ʻo ia hoʻi ke alakaʻi i ka hoʻokumu ʻia ʻana o nā ʻūpā koko. |
| ʻO ka Thromboembolism Venous (VTE) | Hoʻokumu ʻia kahi ʻūpā koko a paʻa i loko o kahi aa koko o ke kino. |
| Ka Pale ʻana i ka Hahau ʻana ma ka Atrial Fibrillation (Afib) | Kāohi i ka hahau ʻana i nā poʻe maʻi me ka ʻole o nā pilikia valve puʻuwai akā he mau puʻuwai kūpaʻa ʻole (Afib). |
| Ma hope o ke ʻoki pani ʻūhā | E hōʻemi i ka pilikia o ke koko i loko o nā wāwae ma hope o ke ʻoki ʻana. |
| ʻO ka Thrombosis Vein Hohonu (DVT) | He ʻūpā koko, ʻoiai hoʻi ma kahi aʻa koko hohonu ma nā wāwae. |
| ʻO ka Embolism Pulmonary | Wehe ʻia kahi ʻūpā koko ma ka wāwae a paʻa i loko o kahi aa koko o ka māmā. |
Eia kekahi, hāʻawi ʻia kēia lāʻau lapaʻau ma ke ʻano he injection i ka wā o nā lāʻau lapaʻau e like me ka angioplasty, kahi e wehe ai i nā aʻa i loko o ka puʻuwai.
Pehea e hana ai kēia lāʻau lapaʻau i loko o ke kino?
He mea maʻalahi loa kēia e hoʻomaopopo. Nui nā mea e pili ana i ke kaʻina hana hoʻopaʻa koko i loko o ko kākou kino. I waena o lākou , ua like ʻo "Thrombin" me ke ʻenekinia nui o kahi hale hana hoʻopaʻa koko. ʻO ia ka mea nāna e kauoha i ke kaʻina hana hoʻopaʻa koko.
No laila, ʻo ka hana a kēia Direct Thrombin Inhibitor, ʻo ia ke hoʻopaʻa pololei ʻana i kēlā mea i kapa ʻia ʻo thrombin a hoʻōki iā ia mai ka hana ʻana i kāna hana. Ua like ia me kekahi e lele ana i mua o kahi mea hana clot koko a keʻakeʻa nei i kā lākou hana. Ke pau ka hana ʻana o thrombin, pau ke kaʻina holoʻokoʻa o ka hoʻokumu ʻana o ke koko.
Akā i kekahi manawa hiki i kēia lāʻau lapaʻau ke hoʻoulu i ke kahe koko nui. I ia mau hihia, aia kahi inikini i kapa ʻia ʻo Idarucizumab e hoʻohuli i nā hopena o ka pila i kapa ʻia ʻo Dabigatran . Eia nō naʻe, ʻaʻohe antidote kikoʻī no nā lāʻau intravenous (IV). Eia nō naʻe, i ka wā e hoʻōki ai ka lāʻau lapaʻau, nalowale kona hopena i ke kino i ka hala ʻana o ka manawa.
He aha nā pono o kēia lāʻau lapaʻau?
Ke hoʻohālikelike ʻia me nā lāʻau hoʻokahe koko kahiko, he nui nā pono o kēia ʻano lāʻau hou.
- ʻOi aku ka kikoʻī o nā hopena:Ma muli o ka hoʻopaʻa wale ʻana o kēia lāʻau i ka thrombin, ua kūlike nā hopena. ʻO ke ʻano kēia hiki iā ʻoe ke manaʻo i nā hopena like i kēlā me kēia manawa āu e lawe ai i ka mahele like. ʻAʻole pono ʻoe e hoʻololi i ka mahele e like me kāu e hana ai me warfarin.
- ʻAʻole hoʻemi i nā platelets koko: ʻAʻole kēia e hoʻemi i nā platelets koko e like me kekahi mau lāʻau lapaʻau.
- ʻAʻohe pono no nā hoʻāʻo koko pinepine: I ka wā e lawe ai iā Warfarin, pono ʻoe e loaʻa nā hoʻāʻo koko maʻamau e nānā i kou helu koko (hoʻāʻo INR). Akā, ʻaʻole koi kēia lāʻau lapaʻau i kēlā.
- Haʻahaʻa ka pilikia a me ka maʻalahi: ʻO Dabigatran, ka mea i lawe ʻia ma ke ʻano he pila, ʻoi aku ka haʻahaʻa o ka pilikia o ke kahe ʻana o ke koko i hoʻohālikelike ʻia me Warfarin. He emi iki hoʻi kona pilina me nā lāʻau lapaʻau ʻē aʻe. He mea maʻalahi loa hoʻi ka hoʻohana ʻana no ka mea hiki ke lawe ʻia i hoʻokahi a ʻelua paha i ka lā.
- He koho ʻē aʻe maikaʻi: He koho ʻē aʻe maikaʻi kēia no ka poʻe hiki ʻole ke lawe i ka lāʻau Heparin.
Pehea ka maikaʻi o kēia lāʻau lapaʻau? Aia kekahi pilikia?
Ua hōʻike ʻia e ka noiʻi ʻana he palekana a maikaʻi kēia lāʻau lapaʻau e like me Warfarin a i ʻole Heparin. Eia nō naʻe, aia kekahi mea nui e mālama ai. ʻAʻole kūpono kēia lāʻau lapaʻau no ka poʻe me nā valves puʻuwai mechanical. Na kāu kauka e aʻo iā ʻoe ma kēia.
ʻO ka ʻokoʻa nui ma waena o kēia mau lāʻau lapaʻau, ʻo ia ko lākou noho ʻana i loko o ke kino no ka manawa pōkole.
E noʻonoʻo, ke lawe ʻoe i kahi mahele o Warfarin, hiki i ka hapalua o ia mea ke noho i loko o kou kino no 20-60 mau hola. Akā ke lawe ʻoe i kahi lāʻau lapaʻau e like me Dabigatran, haʻalele ka hapalua o ia mea i kou kino i loko o 12-14 mau hola.
ʻO ka mea nui e pono ai kākou e hoʻomaopopo mai kēia, ʻaʻole ia he manaʻo maikaʻi e hōʻalo i kahi mahele lāʻau no kekahi kumu . Inā ʻoe e poina i kahi mahele, e nalowale koke ka hopena o ka lāʻau, a hiki ke piʻi koke ka pilikia o ka loaʻa ʻana o kahi ʻūpā koko.
He aha nā hopena ʻaoʻao a me nā pilikia e hiki ke loaʻa?
E like me nā lāʻau lapaʻau a pau, hiki i kēia ke loaʻa nā hopena ʻaoʻao. ʻOiai he mea maʻamau kekahi, pono i nā mea ʻē aʻe ke akahele loa.
ʻO ka hopena ʻaoʻao nui a weliweli loa, ʻo ia ke kahe koko nui (nā pilikia koko). Eia kekahi, hiki ke hana ʻia kēia mau mea:
- ʻO ka ʻeha ʻōpū, ka mumū (Dyspepsia)
- ʻeha ka ʻōpū
- Mimi ʻeleʻele a poni paha
- ʻEha poʻo
- Ke koko haʻahaʻa (Hypotension)
- ʻEha umauma
- Pōʻino
- Paʻakikī ka hanu ʻana
- kuni
- Sepsis (kahi pane koʻikoʻi o ke kino i kahi maʻi)
- Hoʻopau ʻia ka puʻuwai
Āhea wau e kāhea aku ai i ke kauka?
Inā loaʻa iā ʻoe kekahi mau hopena ʻaoʻao i ka wā e hoʻohana ai i kēia lāʻau lapaʻau, e hoʻomaopopo koke i kāu kauka.
ʻOiai inā he mau hōʻailona o ke kahe koko nui, he pilikia ia.Eia kekahi laʻana, inā ʻaʻole e pau ke kahe ʻana o ke koko i kahi ʻeha, inā ʻeleʻele kou mau ʻōpala, inā luaʻi ʻoe i ke koko, a inā loaʻa iā ʻoe kahi ʻeha poʻo nui, e hele koke i ka Emergency Department (ETU) o ka haukapila kokoke loa. Mai hoʻokaʻulua.
Leka Lawe-Home
- He ʻano lāʻau lapaʻau ikaika loa nā Direct Thrombin Inhibitors e pale ai i ke kāpili ʻana o ke koko. E lawe mau i ka nui i kauoha ʻia e kāu kauka, i ka manawa kūpono.
- Mai hōʻalo i kahi mahele lāʻau lapaʻau no kekahi kumu. ʻO ka hana ʻana pēlā e hoʻonui ai i ka pilikia o nā ʻūpā koko. Inā poina iā ʻoe ke lawe i kahi mahele, e nīnau koke i kāu kauka e pili ana i ka mea e hana ai ma hope.
- E makaʻala i nā hōʻailona o ke kahe koko nui (nā ʻōpala ʻeleʻele, ka luaʻi ʻana i ke koko, ke kahe koko mau). Inā hana ʻia kēia, e hele koke i ka ETU.
- ʻAʻole kūpono kēia lāʻau lapaʻau no nā mea āpau (ʻoi aku ka poʻe me nā valves puʻuwai mechanical), no laila e hōʻoia e haʻi i kāu kauka i kāu mōʻaukala olakino piha.
- Ke hana ʻia kekahi lāʻau ʻē aʻe (ʻoiai ka unuhi ʻana i ka niho), e hoʻomaopopo i ke kauka e lawe ana ʻoe i kēia lāʻau.
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