Ikhithi Yokuhlola I-Anticoagulant Therapy

Imele iqembu elivelele le-polysaccharide ekhiqizwa ngokwemvelo, i-heparin yaqanjwa ngenxa yokuhlukaniswa kwayo okokuqala nezicubu zesibindi ekhulwini leminyaka eledlule.Kuze kube manje, i-heparin ibisebenza njengomuthi ojwayelekile we-anticoagulant emisebenzini yomtholampilo amashumi ayisishiyagalombili eminyaka kusukela kwasetshenziswa umuntu wokuqala ngokumelene nokuphazamiseka kwe-thrombotic.Ngokwe-biochemically, isakhiwo esiyisisekelo se-heparin siqukethe amayunithi e-disaccharide aphindaphindayo we-uronic acids (i-L-iduronic noma i-D-glucuronic acid) ne-N-acetyl-D-glucosamine.Ngokuya ngokulandelana okuhlukile kwe-pentasaccharide, i-heparin yenza umsebenzi we-anticoagulant lapho ibopha nge-antithrombin, bese icindezela ukusebenza kwe-factor Xa ne-IIa ku-coagulation cascade.

I-Anti-factor Xa heparin okuqukethwe kwe-heparin enesisindo esiphansi samangqamuzana kanye ne-heparin evamile egazini elisebenzayo ngokuthola umsebenzi we-anti-xa.I-Heparin iyi-anticoagulant evimbela ukujiya kwegazi.Isisindo samangqamuzana namandla omsebenzi we-heparin ahlukile.I-heparin evamile ihlanganisa izinhlobo eziningi zesisindo samangqamuzana, kuyilapho i-heparin enesisindo esiphansi ihlanganisa ama-molecule e-heparin anobubanzi obuncane kanye nesisindo samangqamuzana amancane.Amanye alawa ma-heparin anesisindo esiphansi anesisindo somtholampilo, futhi kunomehluko ocashile phakathi kwalelo nalelo.Kokubili i-heparin evamile ne-heparin enesisindo esiphansi inganikezwa ngomthambo noma ngaphansi kwesikhumba ezigulini ezine-thrombosis noma izandulela.

I-Thrombosis yindlela evamile yokusabela komzimba ekulimaleni kwemithambo yegazi nezicubu.Le nqubo ihilela ukuqaliswa kochungechunge lokujiyisa okuwukuvula uchungechunge lwezici zokujiyisa namaprotheni alawula i-thrombogenesis.Kunezimo eziningi ezinzima nezingapheli, ezifana nokuhlinzwa, i-vein thrombosis ejulile, nezinye izifo ze-hypercoagulable - i-arteriovenous thrombosis, ikakhulukazi emilenzeni.Lawa mahlule angavimba ukugeleza kwegazi futhi abangele ukulimala kwezicubu endaweni ethintekile.Izingcezu zehlule ziyawa bese ziya emaphashini ezidala i-pulmonary embolism;Noma ingafinyelela inhliziyo futhi ibangele isifo senhliziyo.Amahlule e-thrombus kwabesifazane abakhulelwe ngezinye izikhathi angaba nomthelela ekugelezeni kwegazi ku-fetus futhi aholele ekukhipheni isisu.

I-Heparin iphazamisa ukwakheka kwehlule ngokusheshisa ukuvinjelwa kwezinto ezijiyisa (ikakhulukazi i-Xa ne-IIa) ngokusebenza kumaprotheni abizwa ngokuthi i-antithrombin.I-heparin evamile ithinta i-Xa ne-IIa, futhi umsebenzi wokuvimbela izici ze-coagulation uyahluka kakhulu, ngakho-ke kufanele uqashwe ngokucophelela.Izinkinga zihlanganisa i-coagulation, ukopha ngokweqile kanye ne-thrombocytopenia.Ukwelashwa okujwayelekile kwe-heparin kuvame ukulawulwa esibhedlela futhi kuqashwe nge-activated partial thrombokinase time (PTT) noma i-anti-factor Xa heparin.Ukwelashwa kwe-heparin enedosi ephezulu kuvame ukusetshenziswa ezinqubweni zokuhlinza ezifana ne-cardiopulmonary bypass, futhi ukusebenza kahle kugadwa yi-activated clotting time (ACT).I-heparin enesisindo esiphansi se-molecular isebenza kakhulu ngokumelene ne-Xa kune-IIa futhi ukusebenza kwayo kuyabonakala kakhulu.Ukwelashwa kwe-heparin enesisindo esiphansi ngokuvamile kwenziwa ezigulini ezilaliswa ngaphandle noma ezilalisweni, futhi ukuqapha akudingekile ukuze kutholakale ukwelashwa okujwayelekile.Uma kunesidingo, ukusebenza kahle kungabonwa nge-anti-factor Xa heparin.