Kupewa kufalikira kwa thrombus

Palibe kukayikira kuti chitukuko cha anticoagulants chalimbikitsa mwachindunji chithandizo cha DVT.Chithandizo cha anticoagulant chingalepheretse kuchitika kwa thrombus, kuletsa kufalikira kwa thrombus, kumathandizira autolysis ya thrombus ndi recanalization ya lumen, kuchepetsa zizindikiro, komanso kuchepetsa kuchuluka kwa kufa kwa pulmonary embolism.Pakali pano, anticoagulant mankhwala makamaka heparin, otsika maselo kulemera heparin, warfarin, rivaroxaban ndi dabigatran.Aliyense wa mankhwalawa ali ndi ubwino wake ndi kuipa kwake.Poyerekeza ndi heparin yosasinthika, heparin yolemera kwambiri ya maselo apansi pansi kapena kudzera m'mitsempha imatha kuchepetsa kwambiri kufa.Pakati pa oral anticoagulants, warfarin imagwiritsidwa ntchito kwambiri chifukwa cha mtengo wake wotsika, wolondola wa anticoagulant mkati mwa njira yothandiza yochizira (yofunikira kuti chiŵerengero chovomerezeka chapadziko lonse chikhale pakati pa 2 ndi 3).Komabe, chifukwa warfarin imakhudzidwa kwambiri ndi chakudya, zimakhala zosavuta kukhala ndi zovuta monga kusakwanira kwa anticoagulation ndi magazi, ndipo m'pofunika kuyang'anitsitsa ntchito ya coagulation nthawi zonse.M'zaka zaposachedwa, ma anticoagulants atsopano adawonekera pabedi, monga rivaroxaban, dabigatran, apixaban, etc. mphamvu ya anticoagulant ndi yolondola, mavuto a magazi amachepetsedwa, ndipo palibe chifukwa choyang'ananso ntchito ya coagulation.

Pakali pano, akatswiri ena amanena kuti mankhwala mankhwala akhoza kugawidwa mu magawo awiri malinga ndi nthawi kugawikana kwa miyezi 3: gawo loyamba limatchedwa koyamba yogwira mankhwala siteji.Iwo makamaka ikuchitika mkati 3 months pambuyo koyambirira isanayambike dvt3, ndipo gawo lachiwiri amatchedwa kutsatira kubwereza siteji kupewa, amene ikuchitika 3 months pambuyo siteji yoyamba ya mankhwala.Maupangiri a Accp9 adalimbikitsa koyamba ma anticoagulants amkamwa atsopano.Mu kope la 10 la malangizo a American College of Chest Physicians (ACCP), kusiyana kwakukulu kwambiri ndi zakale ndikuti anticoagulants atsopano oral (noac), monga factor Xa inhibitors (rivaroxaban, fondaparinux sodium, etc.) ndi factor IIA inhibitors ( dabigatran, etc.) amagwiritsidwa ntchito ngati chisankho choyamba chochizira VTE.Chithandizo cha anticoagulant chimakhala ndi zotsatira zotsimikizika, chimachepetsa kwambiri zovuta zamagazi, ndipo sichifuna kuwunikanso ntchito ya coagulation.Ikulimbikitsidwanso mwa odwala wamba.Ma anticoagulants atsopano amatha kupewa kuyambiranso kwa DVT mu 80% ~ 92%.

Kuchepetsa kwa mankhwala a anticoagulant okha ndikuti ngakhale kuti mankhwala a anticoagulant nthawi zambiri amagwiritsidwa ntchito kuti achepetse kubwereza kwa thrombus ndikuteteza magwiridwe antchito a venous valve, sangathe kusungunula thrombus mwachangu.Kudziyeretsa kwa thrombus sikudziwika kawirikawiri kwa odwala omwe ali ndi thrombosis ya iliofemoral vein thrombosis, ndipo thrombus yotsalira ingayambitse kuwonongeka kwa valavu ya venous ndi kutsekeka kwa thirakiti, zomwe ndi zifukwa za kuchuluka kwa post thrombosis syndrome (PTS).Kafukufuku wowunikira pakuchitika kwa PTS pambuyo pa chithandizo cha DVT anticoagulant adawonetsa kuti kuchuluka kwa PTS kunali pafupifupi 20% ~ 50%, chiwopsezo cha zilonda zam'mitsempha zam'munsi chinali 5% ~ 10%, ndipo kuchuluka kwa venous claudication kunali 40% pambuyo pa zaka 5.Pafupifupi 15% ya odwala anali ndi vuto loyenda, ndipo moyo wa 100% wa odwalawo unachepetsedwa kukhala magawo osiyanasiyana.