Zotsatirapo zoyipa za mankhwala oletsa magazi kuundana
Mankhwala oletsa magazi kuundana—omwe nthawi zambiri amatchedwa “ochepetsa magazi”—ndi gulu la mankhwala omwe amagwiritsidwa ntchito popewa ndikuchiza magazi kuundana oopsa (thrombi). Ngakhale kuti mawu oti “ochepetsa magazi kuundana” ndi otchuka, mankhwalawa sachepetsa magazi kwenikweni; m'malo mwake, amaletsa njira youndana magazi, zomwe zimapangitsa kuti zikhale zovuta kuti magazi apange magazi kuundana. Mankhwala oletsa magazi kuundana ndi ofunikira pa matenda monga deep vein thrombosis (DVT), pulmonary embolism, atrial fibrillation, komanso kwa odwala omwe ali ndi ma valve amtima opangidwa. Komabe, monga mankhwala ena onse, mankhwala oletsa magazi kuundana ali ndi zotsatirapo zoyipa zomwe ziyenera kumvedwa kuti zigwiritsidwe ntchito bwino komanso mosamala.
Mitundu ya mankhwala oletsa magazi kuundana ndi momwe amagwirira ntchito mwachidule
Musanakambirane za zotsatirapo zake, ndikofunikira kumvetsetsa mankhwala ena oletsa magazi kuundana omwe amagwiritsidwa ntchito kwambiri. Choyamba, warfarin (wotsutsana ndi vitamini K) wakhala akugwiritsidwa ntchito kwa nthawi yayitali ndipo amafunika kuyang'aniridwa nthawi zonse kudzera mu mayeso a INR. Chachiwiri, heparin ndi heparin yolemera pang'ono (LMWH) monga enoxaparin nthawi zambiri amagwiritsidwa ntchito m'zipatala kapena pansi pa mikhalidwe ina chifukwa amagwira ntchito mwachangu. Chachitatu, DOACs/NOACs (Direct Oral Anticoagulants) monga apixaban, rivaroxaban, dabigatran, ndi edoxaban ndi njira zamakono chifukwa nthawi zambiri sizifuna kuyang'aniridwa nthawi zonse kwa INR. Ngakhale kuti njira zawo zimasiyana, zotsatira zoyipa za anticoagulant zimakhala ndi machitidwe ofanana, makamaka okhudzana ndi chiopsezo cha kutuluka magazi.
Zotsatira zoyipa kwambiri: kutuluka magazi
Zotsatirapo zazikulu za mankhwala oletsa magazi kutuluka magazi ndi kutuluka magazi, komwe kumatha kuyambira kofatsa mpaka koika moyo pachiswe. Izi zimachitika chifukwa mankhwalawa amaletsa magazi kuundana, zomwe zimathandiza ngakhale mabala ang'onoang'ono kutuluka magazi kwa nthawi yayitali.
1) Kutuluka magazi pang'ono
Kutuluka magazi pang'ono nthawi zambiri kumachitika m'njira zotsatirazi:
- Kuvulala mosavuta kapena kuvulala popanda kukhudzidwa kulikonse
- Kutuluka magazi m'mphuno komwe kumachitika kawirikawiri kapena kumatenga nthawi yayitali kuti kusiye
- Kutuluka magazi m'kamwa mukamatsuka mano
- Kutuluka magazi pang'ono kuchokera ku mabala ang'onoang'ono omwe ndi ovuta kuwaletsa
– Mwa akazi, msambo umakhala wolemera kapena wautali (menorrhagia)
Ngakhale zingawoneke ngati zazing'ono, kutuluka magazi mobwerezabwereza kuyenera kunenedwa chifukwa kungasonyeze kuti munthu wamwa mankhwala ambiri kapena kuti wamwa mankhwala enaake.
2) Kutuluka magazi pang'ono mpaka kwakukulu
Kutuluka magazi koopsa kwambiri kungaphatikizepo:
– Mkodzo wofiira/wakuda (hematuria)
– Chimbudzi chakuda, chonga phula kapena magazi ofiira atsopano (melena/hematochezia)
- Kutsokomola magazi kapena kusanza magazi (nthawi zina monga khofi)
- Mutu waukulu mwadzidzidzi, kulankhula movutikira, kufooka mbali imodzi ya thupi (kungayambitse kutuluka magazi muubongo)
- Kupweteka kwambiri m'mimba, chizungulire, kufooka kwambiri, kapena kukomoka (kungayambitse kutuluka magazi mkati mwa thupi)
Zizindikiro zimenezi zimafuna thandizo lachipatala mwamsanga, makamaka ngati wodwalayo akukumana ndi kuchepa kwa kuthamanga kwa magazi kapena ngati ali ndi khungu lofiirira.
Zotsatirapo zinazake za mankhwala ena
Kupatula kutuluka magazi, mankhwala ena oletsa magazi kutuluka magazi amakhala ndi zotsatirapo zoyipa.
Warfarin
1. Kuyanjana kwa chakudya ndi mankhwala
Warfarin imakhudzidwa kwambiri ndi kudya vitamini K (monga sipinachi, kale, ndi broccoli). Izi sizikutanthauza kuti muyenera kupewa kudya ndiwo zamasamba, koma kudya vitamini K nthawi zonse ndikofunikira kuti INR ikhale yokhazikika. Warfarin imagwirizananso ndi mankhwala ambiri (monga maantibayotiki ena, maantibayotiki, ndi mankhwala ena opweteka), zomwe zingayambitse kusinthasintha kwa INR.
2. Kutupa kwa khungu
Zotsatira zoyipa zomwe zimachitika kawirikawiri koma zoopsa, zomwe nthawi zambiri zimachitika kumayambiriro kwa chithandizo, zimaphatikizapo kupweteka ndi kusintha kwa khungu, kufiira kenako n’kuda m’malo ena. Izi zimafuna chithandizo chachangu.
3. Kutupa kwa mwana wosabadwayo (koopsa kwa mwana wosabadwayo)
Warfarin ingayambitse matenda m'mwana wosabadwayo kotero nthawi zambiri sivomerezeka pa nthawi ya mimba, makamaka mu trimester yoyamba, pokhapokha ngati dokotala walamula mosamala kwambiri.
Heparin ndi LMWH
1. Kuchuluka kwa magazi m'thupi komwe kumayambitsa matenda a heparin (HIT)
Kachitidwe ka chitetezo chamthupi kameneka kamayambitsa kuchepa kwa ma platelet koma, modabwitsa, kumawonjezera chiopsezo cha magazi kuundana. HIT ndi vuto lalikulu, lomwe nthawi zambiri limawonekera patatha masiku angapo mutagwiritsa ntchito heparin. Zizindikiro zimatha kuphatikizapo thrombosis yatsopano, kupweteka kwa miyendo/kufiira, kapena kuchepa kwa ma platelet pa mayeso a magazi.
2. Matenda a mafupa (osteoporosis) (kugwiritsa ntchito kwa nthawi yayitali)
Pogwiritsa ntchito heparin kwa nthawi yayitali, chiopsezo cha kuchepa kwa mafupa chikhoza kuwonjezeka.
3. Zotsatira za malo obayira jakisoni
LMWH nthawi zambiri imaperekedwa kudzera mu jakisoni wa pansi pa khungu, kotero ingayambitse kupweteka, mabala, kapena chotupa chaching'ono pamalo obayira jakisoni.
DOAC/NOAC (apiksaban, rivaroxaban, dabigatran, edoxaban)
1. Matenda a m'mimba
Odwala ena, makamaka omwe akumwa dabigatran, amatha kukhala ndi kutentha pamtima, nseru, kapena kusamva bwino m'mimba.
2. Chiopsezo cha kutuluka magazi chikupitirirabe
Ngakhale kuti kafukufuku wina akusonyeza kuti mankhwala a DOAC amatha kuchepetsa chiopsezo cha kutuluka magazi muubongo poyerekeza ndi warfarin m'njira zina, mankhwala a DOAC amatha kuyambitsa kutuluka magazi kwambiri, kuphatikizapo m'mimba.
3. Zotsatira pa ntchito ya impso
Ma DOAC ena amadalira kutulutsa impso. Kwa odwala omwe ali ndi vuto la impso, mlingo ungafunike kusinthidwa kapena mankhwala angafunike kusinthidwa kuti apewe kudzikundikira kwa magazi, zomwe zimawonjezera chiopsezo cha kutuluka magazi.
Zinthu zomwe zimawonjezera chiopsezo cha zotsatirapo zoyipa
Si aliyense amene ali pachiwopsezo chofanana. Zina mwa zinthu zomwe zimawonjezera mwayi wokhala ndi zotsatirapo zoyipa za anticoagulant ndi izi:
- Okalamba
– Mbiri yakale ya kutuluka magazi (monga zilonda zam'mimba)
- Kuthamanga kwa magazi kosalamulirika
- Matenda a chiwindi kapena impso
- Kumwa mowa mopitirira muyeso
- Kugwiritsa ntchito mankhwala ena omwe amawonjezera chiopsezo chotuluka magazi, monga aspirin, clopidogrel, NSAIDs (ibuprofen, diclofenac), ma steroids, kapena zowonjezera zina
Choncho, ndikofunikira kuuza dokotala wanu mankhwala onse, zitsamba, ndi zowonjezera zomwe mukumwa panopa.
Kodi muyenera kupeza thandizo lachipatala nthawi yomweyo liti?
Ogwiritsa ntchito mankhwala oletsa magazi kuundana ayenera kupita kuchipatala nthawi yomweyo kapena kulankhulana ndi ogwira ntchito zadzidzidzi ngati akumana ndi izi:
- Kutuluka magazi kosatha pambuyo pokanikiza kwa mphindi 10-15
- Kusanza magazi kapena ndowe zakuda/magazi
- Mkodzo wofiira
- Mutu waukulu mwadzidzidzi, khunyu, chisokonezo, kapena zizindikiro za sitiroko
- Kugwa ndi kumenya mutu ngakhale palibe zizindikiro (chifukwa cha chiopsezo cha kutuluka magazi muubongo)
- Kufooka kwambiri, chizungulire, kupuma movutikira, kapena kukomoka
Ndi bwino kupita kuchipatala msanga kusiyana ndi kudikira kuti zizindikiro zifike poipa.
Momwe mungachepetsere chiopsezo cha zotsatirapo zoyipa
Pali njira zingapo zothandiza zochepetsera chiopsezo:
1. Imwani mankhwala monga mwalangizidwira ndipo musasinthe mlingo popanda malangizo a dokotala.
2. Kuyang'anira nthawi zonse: warfarin imafuna kuwongolera INR; ndi DOACs, kuwongolera magwiridwe antchito a impso/chiwindi kungalimbikitsidwe ngati pakufunika.
3. Pewani mankhwala ena ochepetsa ululu popanda kufunsa dokotala. Pa ululu wochepa, madokotala nthawi zambiri amakonda paracetamol kuposa NSAIDs.
4. Gwiritsani ntchito chitetezo pamene zochita zanu zikuika pachiwopsezo chogwa kapena kuvulala, ndipo samalani ndi malezala/zipangizo zakuthwa.
5. Khalani ndi zakudya zokhazikika, makamaka ndi vitamini K yokhudzana ndi warfarin.
6. Uzani dokotala wanu kuti mukumwa mankhwala oletsa magazi kutuluka magazi musanayambe opaleshoni iliyonse ya mano, opaleshoni, kapena yolowerera m'thupi.
7. Sungani khadi/chiphaso chanu chachipatala chosonyeza kuti mukumwa mankhwala oletsa magazi kutuluka magazi, kuti apolisi athe kuchitapo kanthu mwachangu pakagwa ngozi.
Kutseka
Mankhwala oletsa magazi kuundana ndi mankhwala opulumutsa moyo omwe amaletsa magazi kuundana omwe angayambitse sitiroko, pulmonary embolism, kapena mavuto ena akuluakulu. Komabe, amabwera ndi chiopsezo chowonjezeka cha magazi kutuluka ndi zotsatirapo zinazake kutengera mankhwala. Pomvetsetsa bwino, kuyang'aniridwa bwino, komanso kulankhulana nthawi zonse ndi dokotala wanu, odwala ambiri amatha kugwiritsa ntchito mankhwala oletsa magazi kuundana mosamala komanso moyenera. Ngati mukumva zizindikiro zilizonse za magazi kutuluka kapena zizindikiro zachilendo, musazengereze kufunafuna thandizo lachipatala kuti muchepetse chiopsezo cha mavuto mwamsanga.
