Ente tsa Wessel Douai F: litaelo tsa tšebeliso

Li-antithrombotic agents. Sulodexide.

Khoutu ea PBX B01A B11.

• Angiopathies e nang le kotsi e eketsehang ea thrombosis, incl. thrombosis ka mor'a hore a hlobaetsane le myocardial infarction
• lefu la ho ferekanya kelello: ho otloa ke lefu la sethoathoa (ischemic stroke) le nako ea ho hlaphoheloa kapele ka mor'a lefu la sethoathoa)
• discirculatory encephalopathy e bakoang ke atherosclerosis, lefu la tsoekere, khatello ea mali le methapo ea kelello, le dementia ea methapo,
• Maloetse a amanang le methapo ea methapo ea kutlo le methapo ea lefu la tsoekere
• phlebopathy le vein thrombosis e tebileng
• microangiopathies (nephropathy, retinopathy, neuropathy) le macroangiopathies (lefu la tsoekere la maoto, lefu la pelo (encephalopathy, cardiopathy) ka lebaka la lefu la tsoekere,
• thrombophilia, antiphospholipid syndrome
• heparin thrombocytopenia.

Tekanyetso le tsamaiso

litaelo tse akaretsang

Mekhoa ea phekolo e sebelisoang hangata e kenyelletsa taolo ea batsoali ea lithethefatsi tse lateloang ke li-capsules; maemong a mang, kalafo e nang le Sulodexide e ka qala ka ho toba ho tsoa ho li-capsules. Mokhoa oa kalafo le litekanyetso tse sebetsang li ka fetoloa ho latela qeto ea ngaka motheong oa tlhahlobo ea bongaka le liphetho tsa ho khetholla methati ea laboratori.

Ka kakaretso, li-capsules li khothalletsoa hore li nooe lipakeng tsa lijo, haeba tekanyetso ea letsatsi le letsatsi ea li-capsules e arotsoe ka litekanyetso tse 'maloa, ho khothalletsoa ho boloka karohano ea lihora tse 12 pakeng tsa litekanyetso tsa moriana.

Ka kakaretso, tsela e felletseng ea kalafo e khothalletsoa ho phetoa bonyane makhetlo a 2 ka selemo.

Angiopathies e nang le kotsi e eketsehang ea thrombosis, incl. thrombosis ka mor'a hore a hlobaetsane le myocardial infarction

Khoeling ea pele, ente ea methapo ea 600 LO ea sodeodexide (litaba tsa 1 ea ampoule) e tsamaisoa letsatsi le letsatsi, kamora 'nete ea hore kalafo e ntse e tsoela pele, a nka likhalase tse 1-2 ka molomo habeli ka letsatsi (500-1000 LO / ka letsatsi). Liphetho tse ntle ka ho fetisisa li ka fumaneha haeba kalafo e qalile matsatsing a 10 a pele kamora ho hlaha ha infraction ea myocardial.

Lefu la cerebrovascular: stroke: (stroke's ischemic stroke le ho hlaphoheloa kapele ka mor'a lefu la sethoathoa)

Phekolo e qala ka tsamaiso ea letsatsi le letsatsi ea 600 LO ea sulodexide kapa bolus kapa Drip infusion, eo kahare litaba tsa 1 ampoule ea lithethefatsi li qhaloang ho 150-200 ml ea saline ea mmele. Nako ea ts'oaetso e tsoa ho metsotso e 60 (lebelo la 25-50 le theoha / metsotso) ho isa metsotso e 120 (lebelo la 35-65 le theoha / min). Nako e khothalletsoang ea kalafo ke matsatsi a 15-20. Joale, kalafo e lokela ho tsoelapele ka ts'ebeliso ea li-capsules, tse nkiloeng ka molomo ke pilisi e le 'ngoe habeli ka letsatsi (500 LO / letsatsi) ka matsatsi a 3040.

Atherosulinosis-indept discirculatory encephalopathy, lefu la tsoekere, khatello ea mali le methapo ea kelello le khatello ea maikutlo ea methapo.

Ho khothalletsoa ho nka likhabapo tsa 1-2 tsa moriana habeli ka letsatsi (500-1000 LO / ka letsatsi) ka likhoeli tse 3-6. Nako ea kalafo e ka qala ka ho hlahisoa ha 600 LO sulodexide ka letsatsi bakeng sa matsatsi a 10-30.

Mafu a tšoaetsanoang a methapo ea methapo ea kutlo le methapo ea lefu la tsoekere

Phekolo e qala ka tsamaiso ea methapo ea letsatsi le letsatsi ea 600 LO sulodexide mme e tsoela pele matsatsi a 20-30. Ebe thupelo e ntse e tsoela pele, e nka li-capsules tse 1-2 ka molomo habeli ka letsatsi (500-1000 LO / ka letsatsi) bakeng sa likhoeli tse 2-3.

Phlebopathy le vein thrombosis e tebileng

Khafetsa ho buuoa ka molomo ho sebelisa li-capsule tsa sodeodeide ka tekanyetso ea 500-1000 LO / letsatsi (2 kapa 4 li-capsules) bakeng sa likhoeli tse 2-6. Nako ea kalafo e ka qala ka ho kenyelletsa letsatsi le letsatsi la 600 LO sodeodeide ka letsatsi bakeng sa matsatsi a 10-30.

Microangiopathies (nephropathy, retinopathy, neuropathy) le macroangiopathies (lefu la tsoekere la methapo ea pelo, encephalopathy, cardiopathy) ka lebaka la lefu la tsoekere.

Kalafo ea bakuli ba nang le micro- and macroangiopathies e khothalletsoa ka mekhahlelo e 'meli. Taba ea pele, li-LO tsa 600 tsa sodeodeide li fanoa letsatsi le letsatsi bakeng sa matsatsi a 15, ebe kalafo e ntse e tsoela pele, e nka likhabapo tsa 1-2 habeli ka letsatsi (500-1000 LO / ka letsatsi). Kaha ka kalafo ea nako e khuts'oane sephetho sa eona se ka lahleha ho isa tekanyong e itseng, ho kgothaletsoa ho eketsa nako ea mokhahlelo oa bobeli oa kalafo ho isa bonyane likhoeli tse 4.

Thrombophilia, antiphospholipid syndrome

Mokhoa o tloaelehileng oa kalafo o kenyelletsa ho tsamaisoa ha molomo oa 500-1000 LO sulodexide ka letsatsi (2 kapa 4 li-capsule) bakeng sa likhoeli tse 6-12. Li-capsule tsa Sulodexide hangata li fanoa kamora kalafo e nang le heparin e tlase ea boima ba 'mele ha e kopana le acetylsalicylic acid, mme regimen ea litekanyetso tsa morao-rao ha e hloke ho fetoloa.

heparin thrombocytopenia

Tabeng ea heparin, thrombocytopenia, ho hlahisoa ha heparin kapa hematini e tlase ea boima ba 'mele ho nkela infusion ea sulodexide. Ho etsa sena, lintho tse ka hare ho ampoule e le 'ngoe ea lithethefatsi (600 LO sodeodexide) li kenngoa ka 20 ml ea tharollo ea 0,9% ea sodium chloride mme e fanoa e le infusion e liehang bakeng sa metsotso e 5 (lebelo la 80 lahla / metsotso). Kamora moo, li-LO tsa 600 tsa sodeodexide li hlapolotsoe ka 100 ml ea tharollo ea sodium chloride ea 0,9% 'me ea tsamaisoa ka mokhoa oa li-drip infusions tsa metsotso e 60 (lebelo la 35 ho theoha / metsotso) ka 12:00 ho fihlela ho na le tlhoko ea kalafo ea anticoagulant.

Boikutlo bo fapaneng

Se latelang ke tlhahisoleseling mabapi le karabelo e mpe e bonoang litekong tsa tleleniki tse amang bakuli ba 3258 ba sebelisang tekanyetso e tloaelehileng le mekhoa ea kalafo.

Boitšoaro bo bobe bo amanang le ts'ebeliso ea sodeodexide, e khethollotsoeng ho latela sehlopha sa likarolo tsa tsamaiso ea methapo le khafetsa. Terminology e latelang e sebelisetsoa ho tseba khafetsa ea karabelo e mpe: khafetsa (≥ 1/10), khafetsa (ho tloha 00 1/100 ho isa ho

Bongata

Ho sebelisa moriana o feteletseng oa lithethefatsi ho ka lebisa ho holiseng matšoao a hemorrhagic, a kang hemorrhagic diathesis kapa ho tsoa mali. Maemong a ho tsoa mali, tharollo ea 1% ea protamine sulfate e tlameha ho fanoa. Ka kakaretso, ka mokhoa o feteletseng oa ts'ebeliso ea lithethefatsi o lokela ho khaotsa mme kalafo e loketseng ea matšoao e lokela ho qalisoa.

Sebelisa nakong ea bokhachane kapa ka ho lactation

Kaha ha ho na boiphihlelo ka tšebeliso ea lithethefatsi nakong ea pele ea kemaro, basali ha baa lokela ho fuoa meriana nakong ena, ntle le haeba ka maikutlo a ngaka, moputso o lebelletsoeng oa kalafo bakeng sa mme o feta kotsi e ka bang teng ho lesea.

Ho na le boiphihlelo bo fokolang mabapi le ts'ebeliso ea sodeodexide ho ea bobeli le ea boraro ea bakuli baimana bakeng sa kalafo ea methapo ea methapo e bakoang ke mofuta oa 1 le lefu la tsoekere la II le lefu la ho chesa. Maemong a joalo, sulodexide e ne e fanoa letsatsi le leng le le leng ka methapo ea li-LO tse 600 ka letsatsi bakeng sa matsatsi a 10, kamora moo taolo ea molomo ea moriana e ne e etselitsoe 1 capsule habeli ka letsatsi (500 LOs / letsatsi) ka matsatsi a 15-30. Tabeng ea toxicosis, mofuta ona oa kalafo o ka kopanngoa le mekhoa ea setso ea kalafo.

Nakong ea trimesters ea II le III ea bokhachane, moriana o lokela ho sebelisoa ka hloko, tlasa taolo ea ngaka.

Ha ho ntse ho sa tsejoe hore na sulodexide kapa metabolite ea eona e qapiloe lebeseng la matsoele. Ka hona, ka mabaka a polokeho, ha ho kgothaletswe ho khetha basali nakong ea kemaro.

Ho na le boiphihlelo bo fokolang ka ts'ebeliso ea litokisetso tsa sulodexide kalafo ea lefu la tsoekere lephropathy le glomerulonephritis ho bacha ba lilemo li 13 ho isa ho tse. Maemong a joalo, 600 LO ea sulodexide e ne e fanoa ka methapo letsatsi le letsatsi bakeng sa matsatsi a 15, ebe li-capsules tsa 1-2 tsa moriana li ne li fanoa ka molomo habeli ka letsatsi (500-1000 LO / ka letsatsi) bakeng sa libeke tse peli.

Lintlha tse mabapi le katleho le tšireletso ea lithethefatsi ho bana ba ka tlase ho lilemo tse 12 ha li fumanehe.

Likarolo tsa ts'ebeliso

Nakong ea kalafo, paramente ea hemocoagulation (boikemisetso ba coagulogram) e lokela ho lekoloa nako le nako. Qalong le kamora ho qeta kalafo, ho lokela ho khethoa ka methati e latelang ea laboratori: nako ea ts'ebetso ea karolo e itseng, nako ea ho tsoa mali, le boemo ba antithrombin. Ha u sebelisa lithethefatsi, nako e sebetsang ea "thromboplastin" e sebetsang e eketseha ka makhetlo a ka bang 1.5.

Bokhoni ba ho susumetsa sekhahla sa karabelo ha u khanna kapa u sebetsa ka mekhoa e meng.

Haeba kizungu e bonahala nakong ea kalafo, motho o lokela ho hana ho khanna makoloi le ho sebetsa ka methapo.

Melemo ea pharmacological

Thekhi. Wessel Douai F ke tlhophiso ea sodeodexide, motsoako oa tlhaho oa li-glycosaminoglycans tse arohaneng le mala a ka mpeng a likolobe, e nang le karoloana e kang heparin e nang le boima ba molek'hule e ka bang 8000 Da (80%) le dermatan sulfate (20%).

Sulodexide ke tlhaho e sebelisang antithrombotic, anticoagulants, profibrinolytic le angioprotective effect.

Phello ea anticoagulants ea sodeodexide e bakoa ke kamano ea eona le cofactor heparin II, inhibits thrombin.

Phello ea antithrombotic ea sodeodexide e kenella ka hare ho thibelo ea mesebetsi ea Xa, e khothaletsa motsoako le secretion ea prostacyclin (PGI2) le ho fokotseha hoa plasma fibrinogen.

Phello ea profibrinolytic e bakoa ke keketseho ea tšebetso ea "activator" ea "tis" plasminogen le ho fokotseha hoa ts'ebetso ea inhibitor ea eona.

Matla a angioprotective a amahanngoa le ho khutlisetsa boteng ba sebopeho sa tšebetso le tšebetso ea lisele tsa endothelial le ho thatafala ha letsoalo la qoso e mpe ea li-membrane tsa basement basement.

Ntle le moo, sulodexide e nolofalletsa likarolo tsa mali tsa rheological tsa mali ka ho fokotsa maemo a triglycerides (a amanang le ts'ebetso ea lipoprotein lipase, enzyme e ikarabellang bakeng sa hydrolysis ea triglycerides).

Ho sebetsa ha lithethefatsi ho nephropathy ea lefu la tsoekere ho khethoa ke bokhoni ba li-sodeodex bakeng sa ho fokotsa botebo ba metsoako e ka tlase le tlhahiso ea matrix ea intercellular ka ho fokotsa ho eketseha ha lisele tsa mesangium.

Mofumahali Sulodexide e kenella ka mpeng e nyane. 90% ea lethal dose e fanoang ke sulodexide e bokellana ka har'a vasotine endothelium, moo khatello ea eona e phahameng ka makhetlo a 20-30 ho feta mahloriso liseleng tsa litho tse ling. Sulodexide e tšelisoa ke sebete, mme e ntlafatsoa haholo ke liphio. Ho fapana le heparin e sa fetoloang le boima bo tlase ba heparin, descrateate, e ka lebisang ho fokotseha ha ts'ebetso ea antithrombotic le phallo e kholo ea tlhahiso ea sodeodexide, ha e etsahale. Lithutong tsa ho ajoa ha sodeodeide, ho ile ha bontšoa hore e hloekisoa ke liphio ka bophelo ba halofo e fihlang ho 4:00.

Ho se lumellane

Kaha sulodexide ke polysaccharide e nang le lintho tse nang le asiti e ngata, ha e hlahisoa e le motsoako o kopanetsoeng, e ka theha likarolo le lintho tse ling tse nang le thepa ea mantlha. Lintho tse latelang tse sebelisoang haholo bakeng sa ente e kopaneng ea extemporal ha li lumellane le sodeodexide: vithamine K, motsoako oa livithamini tsa B, hyaluronidase, hydrocortisone, calcium gluconate, traternary ammonium salts, chloramphenicol, tetracycline le streptomycin.