{"id":11183,"date":"2019-06-02T15:02:58","date_gmt":"2019-06-02T08:02:58","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=11183"},"modified":"2025-01-08T23:23:51","modified_gmt":"2025-01-08T16:23:51","slug":"su-dung-hop-ly-an-toan-cac-heparin-khoi-luong-phan-tu-thap","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/su-dung-hop-ly-an-toan-cac-heparin-khoi-luong-phan-tu-thap\/","title":{"rendered":"S\u1eed d\u1ee5ng h\u1ee3p l\u00fd, an to\u00e0n c\u00e1c heparin kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p"},"content":{"rendered":"

Theo Canhgiacduoc<\/em><\/strong><\/p>\n

S\u1eec D\u1ee4NG H\u1ee2P L\u00dd, AN TO\u00c0N C\u00c1C HEPARIN KH\u1ed0I L\u01af\u1ee2NG PH\u00c2N T\u1eec TH\u1ea4P<\/strong><\/p>\n

\u00a0Nguy\u1ec5n Duy H\u01b0ng, Ho\u00e0ng H\u00e0 Ph\u01b0\u01a1ng<\/em><\/p>\n

T\u00f3m t\u1eaft<\/strong><\/p>\n

Heparin l\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam. Trong khi heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n t\u00e1c d\u1ee5ng tr\u00ean y\u1ebfu t\u1ed1 IIa v\u00e0 Xa th\u00ec heparin kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (KLPTT) v\u00e0 fondaparinux (pentasacarid) t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu th\u00f4ng qua c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xa. \u0110i\u1ec3m \u0111\u00e1ng ch\u00fa \u00fd c\u1ee7a heparin KLPTT l\u00e0 th\u1eddi gian b\u00e1n th\u1ea3i (t1\/2) d\u00e0i n\u00ean ch\u1ec9 c\u1ea7n ti\u00eam 1-2 l\u1ea7n\/ng\u00e0y. Th\u00f4ng th\u01b0\u1eddng, thu\u1ed1c ch\u1ec9 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t th\u1eddi gian, sau \u0111\u00f3 s\u1ebd \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng m\u1ed9t thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng nh\u01b0 thu\u1ed1c kh\u00e1ng vitamin K \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i. Khi s\u1eed d\u1ee5ng, c\u1ea7n l\u01b0u \u00fd t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u00e0 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 ch\u1ea3y m\u00e1u.<\/p>\n

\"\"<\/p>\n

N\u1ed9i dung b\u00e0i<\/strong><\/p>\n

Heparin KLPTT l\u00e0 h\u1ed7n h\u1ee3p kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t c\u1ee7a c\u00e1c mucopolysacarid sulfat. Kh\u00e1c v\u1edbi heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n \u0111\u01b0\u1ee3c chi\u1ebft t\u1eeb ru\u1ed9t l\u1ee3n, c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed t\u1eeb 4000 – 30.000 dalton, heparin KLPTT \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1eb1ng con \u0111\u01b0\u1eddng b\u00e1n t\u1ed5ng h\u1ee3p v\u00e0 c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed trung b\u00ecnh l\u00e0 5000 dalton. Hi\u1ec7n c\u00f3 4 lo\u1ea1i heparin KLPTT l\u01b0u h\u00e0nh tr\u00ean th\u1ecb tr\u01b0\u1eddng v\u1edbi c\u00e1ch t\u1ed5ng h\u1ee3p ph\u1ee5 thu\u1ed9c v\u00e0o t\u1eebng c\u00f4ng ty s\u1ea3n xu\u1ea5t: depolymer h\u00f3a b\u1eb1ng acid nitr\u01a1 (dalteparin v\u00e0 nadroparin), depolymer h\u00f3a trong ki\u1ec1m v\u00e0 benzyl h\u00f3a (enoxaparin), depolymer h\u00f3a b\u1eb1ng enzym heparinase (tinzaparin).<\/p>\n

C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u00fd<\/strong><\/p>\n

M\u1eb7c d\u00f9 kh\u00e1c nhau v\u1ec1 \u0111\u1ed9 d\u00e0i c\u00e1c chu\u1ed7i mucopolysacarid sulfat, t\u1ea5t c\u1ea3 c\u00e1c heparin KLPTT \u0111\u1ec1u c\u00f3 m\u1ed9t v\u00f9ng c\u00f3 5 ph\u00e2n t\u1eed \u0111\u01b0\u1eddng \u0111\u1eb7c hi\u1ec7u. Nh\u1edd c\u00f3 v\u00f9ng pentasacarid n\u00e0y, heparin KLPTT c\u00f3 th\u1ec3 g\u1eafn v\u1edbi antithrombin III v\u00e0 gia t\u0103ng t\u1ed1c \u0111\u1ed9 ph\u1ea3n \u1ee9ng\u00a0(l\u01b0u \u00fd 1)<\/em>. Vi\u1ec7c khuy\u1ebfch \u0111\u1ea1i ho\u1ea1t t\u00ednh c\u1ee7a antithrombin III d\u1eabn \u0111\u1ebfn t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng c\u1ee7a heparin KLPTT. Tr\u00ean th\u1ef1c t\u1ebf, qu\u00e1 tr\u00ecnh \u1ee9c ch\u1ebf thrombin (y\u1ebfu t\u1ed1 IIa) c\u1ea7n s\u1ef1 li\u00ean k\u1ebft \u0111\u1ed3ng th\u1eddi c\u1ee7a chu\u1ed7i heparin v\u1edbi antithrombin III v\u00e0 thrombin, trong khi \u0111\u00f3 qu\u00e1 tr\u00ecnh \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xa ch\u1ec9 c\u1ea7n li\u00ean k\u1ebft gi\u1eefa chu\u1ed7i heparin v\u00e0 antithrombin III. Tr\u00ean c\u01a1 s\u1edf \u0111\u00f3, nh\u1eefng chu\u1ed7i kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed d\u01b0\u1edbi 5400 dalton ch\u1ec9 c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng Xa trong khi nh\u1eefng chu\u1ed7i c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed l\u1edbn h\u01a1n 5400 dalton c\u00f3 c\u1ea3 t\u00e1c d\u1ee5ng kh\u00e1ng IIa. C\u00e1c heparin KLPTT c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed nh\u1ecf n\u00ean c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng Xa m\u1ea1nh h\u01a1n t\u00e1c d\u1ee5ng kh\u00e1ng IIa, v\u1edbi t\u1ef7 l\u1ec7 ho\u1ea1t t\u00ednh kh\u00e1ng Xa\/kh\u00e1ng IIa dao \u0111\u1ed9ng t\u1eeb 2-4 l\u1ea7n t\u00f9y theo thu\u1ed1c.<\/p>\n\n\n\n\n\n\n\n\n
B\u1ea3ng 1: M\u1ed9t s\u1ed1 heparin KLPTT \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00ed l\u01b0u h\u00e0nh t\u1ea1i Vi\u1ec7t Nam<\/td>\n<\/tr>\n
Lo\u1ea1i<\/td>\nHo\u1ea1t ch\u1ea5t<\/td>\nBi\u1ec7t d\u01b0\u1ee3c<\/td>\nD\u1ea1ng tr\u00ecnh b\u00e0y<\/td>\nTh\u1eddi gian<\/p>\n

b\u00e1n th\u1ea3i (gi\u1edd)<\/td>\n<\/tr>\n

Heparin KLPTT<\/td>\nDalteparin<\/td>\nConpac<\/td>\nDung d\u1ecbch ti\u00eam 2500 IU\/ml<\/td>\n3-4<\/td>\n<\/tr>\n
Nadroparin<\/td>\nFraxiparine<\/td>\nDung d\u1ecbch ti\u00eam 2850 anti-Xa IU\/0,3 ml; 3800 IU\/0,4 ml<\/td>\n3-4<\/td>\n<\/tr>\n
Enoxaparin<\/td>\nLovenox, Troynoxa, Enoxaplen,
\nGemapaxane<\/td>\n		Dung d\u1ecbch ti\u00eam 20 mg; 40 mg;
\n60 mg; 2000 IU\/0,2 ml; 4000 IU\/0,4 ml;
\n6000 IU\/0,6 ml<\/td>\n		4-7<\/td>\n<\/tr>\n
Pentasacarid<\/td>\nFondaparinux<\/td>\nArixtra<\/td>\nDung d\u1ecbch ti\u00eam 2,5 mg\/0,5 ml<\/td>\n17-21<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Do c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf n\u00ean thu\u1ed1c ch\u1ec9 c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xa. C\u00e1c chu\u1ed7i
\npolysacarid khi d\u00f9ng b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng s\u1ebd b\u1ecb ph\u00e2n h\u1ee7y tr\u01b0\u1edbc khi h\u1ea5p thu n\u00ean c\u00e1c heparin KLPTT v\u00e0 pentasacarid s\u1ebd \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u01b0\u1eddng ti\u00eam, th\u00f4ng th\u01b0\u1eddng l\u00e0 ti\u00eam d\u01b0\u1edbi da\u00a0(b\u1ea3ng 2)<\/em>. Th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a c\u00e1c heparin KLPTT kho\u1ea3ng 4 gi\u1edd (d\u00e0i h\u01a1n r\u1ea5t nhi\u1ec1u so v\u1edbi th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n: 60-90 ph\u00fat).<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh<\/p>\n

\u2022 Ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch:\u00a0<\/em>Heparin KLPTT ch\u1ec9 \u0111\u01b0\u1ee3c d\u00f9ng trong m\u1ed9t kho\u1ea3ng th\u1eddi gian ng\u1eafn, sau \u0111\u00f3 s\u1ebd \u0111\u01b0\u1ee3c chuy\u1ec3n sang d\u00f9ng thu\u1ed1c kh\u00e1ng vitamin K khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i\u00a0(b\u1ea3ng 3)<\/em>. Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng heparin v\u1eabn l\u00e0 bi\u1ec7n ph\u00e1p c\u01a1 b\u1ea3n trong d\u1ef1 ph\u00f2ng bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 nguy c\u01a1.<\/p>\n\n\n\n\n\n\n\n\n
B\u1ea3ng 2: D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a heparin KLPTT<\/td>\n<\/tr>\n
H\u1ea5p thu<\/td>\nSinh kh\u1ea3 d\u1ee5ng \u0111\u1ea1t 98% sau khi ti\u00eam d\u01b0\u1edbi da<\/td>\n<\/tr>\n
Chuy\u1ec3n h\u00f3a<\/td>\nCh\u1ee7 y\u1ebfu \u1edf gan (ph\u1ea3n \u1ee9ng desulfat v\u00e0 depolymer h\u00f3a)<\/td>\n<\/tr>\n
Th\u1ea3i tr\u1eeb<\/td>\nQua th\u1eadn<\/td>\n<\/tr>\n
Th\u1eddi gian b\u00e1n th\u1ea3i<\/td>\nKho\u1ea3ng 4 gi\u1edd<\/td>\n<\/tr>\n
Th\u1eddi gian duy tr\u00ec t\u00e1c d\u1ee5ng<\/td>\n12-24 gi\u1edd<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u2022 H\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p:\u00a0<\/em>Hi\u1ec7n c\u00e1c thu\u1ed1c heparin KLPTT (Lovenox, Fraxiparine) v\u00e0 Arixtra \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t ch\u1ec9 \u0111\u1ecbnh k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u trong tr\u01b0\u1eddng h\u1ee3p \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim.<\/p>\n

\u2022 Ch\u1ec9 \u0111\u1ecbnh kh\u00e1c:<\/em>\u00a0Huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0 d\u1ef1 ph\u00f2ng \u0111\u00f4ng m\u00e1u tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3 trong qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u.<\/p>\n

L\u01b0u \u00fd 1:<\/em><\/p>\n

Hai \u0111i\u1ec1u ki\u1ec7n c\u1ea7n c\u00f3 \u0111\u1ec3 heparin ph\u00e1t huy t\u00e1c d\u1ee5ng:<\/p>\n

– B\u00ecnh th\u01b0\u1eddng v\u1ec1 c\u1ea3 s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng antithrombin III.<\/p>\n

– V\u00f9ng pentasacarid c\u1ee7a ph\u00e2n t\u1eed heparin ph\u1ea3i c\u00f3 m\u1eb7t \u1edf \u00edt nh\u1ea5t 1\/3 s\u1ed1 chu\u1ed7i.<\/p>\n\n\n\n\n\n\n\n\n\n\n
B\u1ea3ng 3: \u0110i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/td>\n<\/tr>\n
Ch\u1ec9 \u0111\u1ecbnh<\/em><\/td>\nTh\u1eddi gian<\/em><\/td>\n<\/tr>\n
D\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u: ti\u00eam d\u01b0\u1edbi da 1 l\u1ea7n\/ng\u00e0y<\/td>\n<\/tr>\n
Tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt<\/em><\/td>\nDalteparin 5000 IU ho\u1eb7c enoxaparin 4000 IU ho\u1eb7c fondaparinux 2,5 mg<\/td>\nT\u1ed1i \u0111a 10 ng\u00e0y cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ef1
\nsinh ho\u1ea1t tr\u1edf l\u1ea1i<\/td>\n<\/tr>\n
Tr\u01b0\u1eddng h\u1ee3p th\u1eddi gian n\u1eb1m vi\u1ec7n k\u00e9o d\u00e0i do c\u00e1c b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh<\/em><\/td>\nDalteparin 5000 IU ho\u1eb7c enoxaparin 4000 IU ho\u1eb7c fondaparinux 2,5 mg<\/td>\nT\u1ed1i \u0111a 14 ng\u00e0y<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i: ti\u00eam d\u01b0\u1edbi da 2 l\u1ea7n\/ng\u00e0y (tr\u1eeb Arixtra: ti\u00eam 1 l\u1ea7n\/ng\u00e0y)<\/td>\n<\/tr>\n
Tr\u01b0\u1eddng h\u1ee3p t\u00ecnh tr\u1ea1ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh<\/em><\/td>\nDalteparin: 100 IU anti-Xa\/kg Enoxaparin: 100 IU anti-Xa\/kg<\/p>\n

Nadroparin: 85 IU anti-Xa\/kg<\/p>\n

Fondaparinux (Arixtra): 7,5 mg (5 mg n\u1ebfu\u00a0 c\u00e2n n\u1eb7ng b\u1ec7nh nh\u00e2n < 50 kg ho\u1eb7c 10 mg n\u1ebfu c\u00e2n n\u1eb7ng b\u1ec7nh nh\u00e2n > 100 kg)<\/td>\n

T\u1ed1i \u0111a 10 ng\u00e0y sau \u0111\u00f3 thay b\u1eb1ng c\u00e1c thu\u1ed1c kh\u00e1ng vitamin K \u0111\u01b0\u1eddng u\u1ed1ng<\/td>\n<\/tr>\n
Tr\u01b0\u1eddng h\u1ee3p
\nt\u1eafc m\u1ea1ch ph\u1ed5i<\/em><\/td>\n		Enoxaparin: 100 IU anti-Xa\/kg<\/p>\n

Tinzaparin (Innohep): 175 IU anti-Xa\/kg<\/p>\n

Fondaparinux (Arixtra): 7,5 mg (5 mg n\u1ebfu c\u00e2n n\u1eb7ng b\u1ec7nh nh\u00e2n < 50 kg ho\u1eb7c 10 mg n\u1ebfu c\u00e2n n\u1eb7ng b\u1ec7nh nh\u00e2n > 100 kg)<\/td>\n

T\u1ed1i \u0111a 10 ng\u00e0y sau \u0111\u00f3 thay b\u1eb1ng c\u00e1c thu\u1ed1c kh\u00e1ng vitamin K \u0111\u01b0\u1eddng u\u1ed1ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i:<\/em><\/strong><\/p>\n

– Ti\u1ec1n s\u1eed gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin KLPTT ho\u1eb7c heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n.<\/p>\n

– Hi\u1ec7n \u0111ang ch\u1ea3y m\u00e1u ho\u1eb7c c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u do r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u01a1 quan d\u1ec5 ch\u1ea3y m\u00e1u.<\/p>\n

– Ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd.<\/p>\n

– G\u00e2y t\u00ea ngo\u00e0i m\u00e0ng c\u1ee9ng ho\u1eb7c g\u00e2y t\u00ea t\u1ee7y s\u1ed1ng.<\/p>\n

– Ti\u00eam b\u1eafp.<\/p>\n

– Suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng (\u0111\u1ed9 thanh th\u1ea3i creatinin < 30 ml\/ph\u00fat). Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n d\u1ea1ng calciparin l\u00e0 thu\u1ed1c duy nh\u1ea5t c\u00f3 th\u1ec3 d\u00f9ng.<\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i:<\/em><\/strong><\/p>\n

– Tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 trong giai \u0111o\u1ea1n c\u1ea5p t\u00ednh.<\/p>\n

– Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c c\u1ea5p.<\/p>\n

– Suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn m\u1ee9c \u0111\u1ed9 t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh (\u0111\u1ed9 thanh th\u1ea3i creatinin < 60 ml\/ph\u00fat).<\/p>\n

Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng:<\/em><\/strong><\/p>\n

– T\u00ecm ki\u1ebfm c\u00e1c d\u1ea5u hi\u1ec7u xu\u1ea5t huy\u1ebft: Trong tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u, ph\u1ea3i l\u00e0m r\u00f5 nguy\u00ean nh\u00e2n v\u00e0 c\u00f3 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn: Tr\u01b0\u1edbc khi b\u1eaft \u0111\u00e2u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng heparin KLPTT, nh\u1ea5t thi\u1ebft ph\u1ea3i \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi b\u1ec7nh nh\u00e2n tr\u00ean 75 tu\u1ed5i. T\u00ednh \u0111\u1ed9 thanh th\u1ea3i creatinin d\u1ef1a tr\u00ean c\u00f4ng th\u1ee9c Cockcroft:<\/p>\n

\u0110\u1ed9 thanh th\u1ea3i creatinin (ml\/ph\u00fat)<\/em><\/p>\n

[140 – tu\u1ed5i (n\u0103m)] x c\u00e2n n\u1eb7ng (kg)<\/p>\n

0,814\u00a0 x creatinin huy\u1ebft thanh (micromol\/l) (v\u1edbi ph\u1ee5 n\u1eef, nh\u00e2n k\u1ebft qu\u1ea3 v\u1edbi 0,85).<\/p>\n

S\u1eed d\u1ee5ng thu\u1ed1c \u1edf ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa<\/strong><\/p>\n

Heparin KLPTT kh\u00f4ng qua \u0111\u01b0\u1ee3c nhau thai. Tuy nhi\u00ean, t\u1ea5t c\u1ea3 c\u00e1c bi\u1ec7t d\u01b0\u1ee3c c\u1ee7a heparin KLPTT \u0111\u1ec1u kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i cho ph\u1ee5 n\u1eef c\u00f3 thai. Ngo\u1ea1i tr\u1eeb
\nInnohep kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng cho ph\u1ee5 n\u1eef c\u00f3 thai \u1edf m\u1ecdi giai \u0111o\u1ea1n c\u1ee7a thai k\u1ef3, nh\u1eefng heparin KLPTT kh\u00e1c v\u1eabn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u1edf li\u1ec1u d\u1ef1 ph\u00f2ng trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n thi\u1ebft, sau khi \u0111\u00e3 c\u00e2n nh\u1eafc l\u1ee3i \u00edch\/nguy c\u01a1 c\u1ee7a thu\u1ed1c. C\u00e1c thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1ee3c trong th\u1eddi k\u1ef3 cho con b\u00fa.<\/p>\n

T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/p>\n

– Nguy c\u01a1 ch\u1ea3y m\u00e1u<\/em>, \u0111\u1eb7c bi\u1ec7t trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng tu\u00e2n th\u1ee7 v\u1ec1 li\u1ec1u, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u00e0 l\u01b0u \u00fd \u0111\u1ebfn tu\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

– T\u1ee5 m\u00e1u t\u1ea1i v\u1ecb tr\u00ed ch\u1ed7 ti\u00eam<\/em>\u00a0c\u00f3 th\u1ec3 x\u1ea3y ra sau khi c\u00f3 ban xu\u1ea5t huy\u1ebft.<\/p>\n

– Gi\u1ea3m ti\u1ec3u c\u1ea7u:<\/em>\u00a0Th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 typ 1, m\u1ee9c \u0111\u1ed9 trung b\u00ecnh (ti\u1ec3u c\u1ea7u < 100.000 t\u1ebf b\u00e0o\/mm3), xu\u1ea5t hi\u1ec7n s\u1edbm v\u00e0 kh\u00f4ng c\u1ea7n ng\u1eebng \u0111i\u1ec1u tr\u1ecb. Hi\u1ebfm g\u1eb7p gi\u1ea3m ti\u1ec3u c\u1ea7u d\u1ecb \u1ee9ng mi\u1ec5n d\u1ecbch typ\u00a0 2.<\/p>\n

– C\u00e1c d\u1ecb \u1ee9ng hi\u1ebfm g\u1eb7p,<\/em>\u00a0tr\u00ean da ho\u1eb7c to\u00e0n th\u00e2n.<\/p>\n

– Nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng<\/em>\u00a0trong tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb d\u00e0i ng\u00e0y.<\/p>\n

– T\u0103ng enzym gan transaminase tho\u00e1ng qua.<\/em><\/p>\n

– Hi\u1ebfm g\u1eb7p, t\u0103ng kali m\u00e1u ho\u1eb7c t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan.<\/em><\/p>\n

T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/strong><\/p>\n

Kh\u00f4ng c\u00f3 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c n\u00e0o \u0111\u01b0\u1ee3c coi l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi heparin KLPTT v\u1edbi nh\u1eefng thu\u1ed1c kh\u00e1c c\u00f3 t\u00e1c d\u1ee5ng l\u00ean qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u c\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u v\u00e0 t\u0103ng kali m\u00e1u.<\/p>\n

Nguy c\u01a1 ch\u1ea3y m\u00e1u:<\/em><\/p>\n

– Thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u: ticlodipin (Ticlid), clopidogrel (Plavix), abciximab (Reopro), tirofiban (Agrastat)\u2026<\/p>\n

– S\u1eed d\u1ee5ng corticoid to\u00e0n th\u00e2n v\u1edbi li\u1ec1u cao ho\u1eb7c trong th\u1eddi gian d\u00e0i (> 10 ng\u00e0y): nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c ti\u00eau h\u00f3a ho\u1eb7c c\u00e1c m\u1ea1ch m\u00e1u nh\u1ecf.<\/p>\n

– Thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAIDs) \u0111\u01b0\u1eddng to\u00e0n th\u00e2n: \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a ti\u1ec3u c\u1ea7u v\u00e0 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c ti\u00eau h\u00f3a.<\/p>\n

– Acid acetylsalicylic (aspirin) v\u00e0 c\u00e1c salicylic kh\u00e1c s\u1eed d\u1ee5ng \u1edf li\u1ec1u gi\u1ea3m \u0111au, h\u1ea1 s\u1ed1t ho\u1eb7c ch\u1ed1ng vi\u00eam.<\/p>\n

Nguy c\u01a1 t\u0103ng kali m\u00e1u khi ph\u1ed1i h\u1ee3p v\u1edbi:<\/em><\/p>\n

– Thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAIDs).<\/p>\n

– Ciclosporin (Neoral).<\/p>\n

– Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali (spironolacton, amilorid).<\/p>\n

– Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 AT1 (sartans).<\/p>\n

– Trimethoprim (Bactrim, Cotrimoxazol).<\/p>\n

– Mu\u1ed1i kali (Diffu-K, Kaleorid\u2026).<\/p>\n

Ph\u1ed1i h\u1ee3p thu\u1ed1c<\/strong><\/p>\n

– Thay th\u1ebf heparin KLPTT b\u1eb1ng thu\u1ed1c kh\u00e1ng vitamin K:<\/em>\u00a0tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed g\u1eb7p bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch ho\u1eb7c sau ph\u1eabu thu\u1eadt tim m\u1ea1ch, vi\u1ec7c thay th\u1ebf heparin KLPTT b\u1eb1ng m\u1ed9t thu\u1ed1c kh\u00e1ng vitamin K l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng heparin KLPTT kh\u00f4ng qu\u00e1 d\u00e0i. Tr\u00ean th\u1ef1c t\u1ebf, vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi 2 thu\u1ed1c th\u01b0\u1eddng ch\u1ec9 k\u00e9o d\u00e0i t\u1eeb 2-5 ng\u00e0y. Heparin s\u1ebd \u0111\u01b0\u1ee3c d\u1eebng khi ch\u1ec9 s\u1ed1 INR n\u1eb1m trong kho\u1ea3ng m\u1ee5c ti\u00eau (t\u1eeb 2-3).<\/p>\n

– Thay th\u1ebf thu\u1ed1c kh\u00e1ng vitamin K b\u1eb1ng heparin KLPTT:<\/em>\u00a0\u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng vitamin K, tr\u01b0\u1edbc khi tr\u1ea3i qua can thi\u1ec7p b\u1eb1ng ph\u1eabu thu\u1eadt, c\u1ea7n ph\u1ea3i theo d\u00f5i INR trong v\u00f2ng 7-10 ng\u00e0y tr\u01b0\u1edbc can thi\u1ec7p. N\u1ebfu gi\u00e1 tr\u1ecb cu\u1ed1i c\u00f9ng n\u1eb1m trong kho\u1ea3ng \u0111i\u1ec1u tr\u1ecb, thu\u1ed1c kh\u00e1ng vitamin K s\u1ebd \u0111\u01b0\u1ee3c d\u1eebng 4-5 ng\u00e0y tr\u01b0\u1edbc khi can thi\u1ec7p v\u00e0 thay th\u1ebf b\u1eb1ng heparin KLPTT \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb:<\/p>\n

48 gi\u1edd sau l\u1ea7n cu\u1ed1i d\u00f9ng warfarin (Coumadin).<\/p>\n

24 gi\u1edd sau l\u1ea7n cu\u1ed1i d\u00f9ng acenocoumarol (Sintrom).<\/p>\n

Ngo\u00e0i ra, c\u1ea7n x\u00e1c \u0111\u1ecbnh ch\u1ec9 s\u1ed1 INR tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt do nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 INR > 1,5 t\u1ea1i th\u1eddi \u0111i\u1ec3m n\u00e0y ph\u1ea3i d\u00f9ng th\u00eam 5 mg vitamin K \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

Nguy\u00ean t\u1eafc k\u00ea \u0111\u01a1n<\/strong><\/p>\n

C\u1ea7n ti\u1ebfn h\u00e0nh c\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u0103m d\u00f2 bilan sinh h\u00f3a\/huy\u1ebft h\u1ecdc tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb:<\/em><\/p>\n

– S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u.<\/p>\n

– Ch\u1ee9c n\u0103ng th\u1eadn (thanh th\u1ea3i creatinin).<\/p>\n

Theo d\u00f5i c\u00e1c ch\u1ec9 s\u1ed1 sinh h\u1ecdc:\u00a0<\/em>trong m\u1ecdi tr\u01b0\u1eddng h\u1ee3p, c\u1ea7n theo d\u00f5i s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u 2 l\u1ea7n\/tu\u1ea7n trong 1 th\u00e1ng, sau \u0111\u00f3 1 l\u1ea7n\/th\u00e1ng. Trong c\u1ea3 tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng v\u1edbi m\u1ee5c \u0111\u00edch d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng heparin KLPTT kh\u00f4ng y\u00eau c\u1ea7u ph\u1ea3i theo d\u00f5i ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u, ngo\u1ea1i tr\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t nh\u01b0 b\u1ec7nh nh\u00e2n cao tu\u1ed5i, c\u00f3 c\u00e2n n\u1eb7ng d\u01b0\u1edbi 40 kg ho\u1eb7c tr\u00ean 100 kg, c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn c\u1ed1 ch\u1ea3y m\u00e1u\u00a0(l\u01b0u \u00fd 2)<\/em>.<\/p>\n

L\u01b0u \u00fd 2:<\/em><\/p>\n

Vi\u1ec7c theo d\u00f5i ch\u1ec9 s\u1ed1 sinh h\u1ecdc \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng heparin KLPTT kh\u00f4ng nghi\u00eam ng\u1eb7t nh\u01b0 v\u1edbi b\u1ec7nh nh\u00e2n d\u00f9ng heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n do thu\u1ed1c c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u c\u0169ng nh\u01b0 nguy c\u01a1 gi\u1ea3m ti\u1ec3u c\u1ea7u th\u1ea5p h\u01a1n v\u00e0 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i h\u01a1n heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n.\u00a0<\/em><\/p>\n

\u00a0\u00a0\u00a0<\/em><\/p>\n\n\n\n\n\n\n\n
B\u1ea3ng 4: Li\u1ec1u d\u1ef1 ph\u00f2ng c\u1ee7a heparin KLPTT<\/td>\n<\/tr>\n
Thu\u1ed1c<\/td>\nLi\u1ec1u<\/td>\n<\/tr>\n
Dalteparin<\/td>\n2500-5000 IU<\/p>\n

Ti\u00eam d\u01b0\u1edbi da 1 l\u1ea7n\/ng\u00e0y<\/td>\n<\/tr>\n

Nadroparin<\/p>\n

(Fraxiparine)<\/td>\n

C\u00e2n n\u1eb7ng:<\/p>\n

D\u01b0\u1edbi 51 kg: 0,2-0,3 ml\/ng\u00e0y<\/p>\n

51-70 kg: 0,3-0,4 ml\/ng\u00e0y<\/p>\n

Tr\u00ean 70 kg: 0,3-0,6 ml\/ng\u00e0y<\/p>\n

Ti\u00eam d\u01b0\u1edbi da 1 l\u1ea7n\/ng\u00e0y<\/td>\n<\/tr>\n

Enoxaparin (Lovenox)<\/td>\nT\u1eeb 2000 IU\/0,2 ml \u0111\u1ebfn 4000 IU\/0,4 ml<\/p>\n

Ti\u00eam d\u01b0\u1edbi da 1 l\u1ea7n\/ng\u00e0y<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– Li\u1ec1u d\u00f9ng v\u00e0 nh\u1ecbp \u0111\u01b0a thu\u1ed1c:<\/em>\u00a0li\u1ec1u d\u00f9ng c\u1ee7a heparin KLPTT \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn d\u1ef1a tr\u00ean ch\u1ec9 \u0111\u1ecbnh v\u00e0 c\u00e2n n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u00e2n\u00a0(b\u1ea3ng 4)<\/em>. T\u00f9y theo t\u1eebng thu\u1ed1c v\u00e0 ch\u1ec9 \u0111\u1ecbnh, c\u00f3 th\u1ec3 ti\u00eam d\u01b0\u1edbi da 1-2 l\u1ea7n\/ng\u00e0y.<\/p>\n

Khuy\u1ebfn c\u00e1o k\u00e8m theo<\/strong><\/p>\n

Vi\u1ec7c ph\u00f2ng ng\u1eeba huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u bao g\u1ed3m c\u1ea3 nh\u1eefng bi\u1ec7n ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c:<\/p>\n

– Tr\u00e1nh n\u1eb1m c\u1ed1 \u0111\u1ecbnh m\u1ed9t ch\u1ed7 trong th\u1eddi gian d\u00e0i.<\/p>\n

– C\u00e1c bi\u1ec7n ph\u00e1p k\u00ecm ch\u1ebf c\u01a1 h\u1ecdc (vi\u1ec7c d\u00f9ng b\u0103ng \u00e9p t\u0129nh m\u1ea1ch l\u00e0 b\u1eaft bu\u1ed9c khi s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i).<\/p>\n

– Trong ph\u1eabu thu\u1eadt, s\u1eed d\u1ee5ng bi\u1ec7n ph\u00e1p g\u00e2y t\u00ea t\u1ee7y s\u1ed1ng v\u00e0 v\u1eadn \u0111\u1ed9ng s\u1edbm.<\/p>\n

– V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao, theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng \u1edf ch\u00e2n.<\/p>\n

M\u1ed9t \u0111i\u1ec1u r\u1ea5t quan tr\u1ecdng v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng heparin KLPTT l\u00e0 c\u1ea7n gi\u00fap b\u1ec7nh nh\u00e2n hi\u1ec3u v\u1ec1 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb (t\u01b0 v\u1ea5n cho b\u1ec7nh nh\u00e2n c\u00e1ch thao t\u00e1c trong tr\u01b0\u1eddng h\u1ee3p t\u1ef1 ti\u00eam thu\u1ed1c) v\u00e0 nh\u1eadn bi\u1ebft nh\u1eefng d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng:<\/p>\n

– D\u1ea5u hi\u1ec7u ch\u1ea3y m\u00e1u:<\/em><\/p>\n

+ Ch\u1ea3y m\u00e1u m\u0169i.<\/p>\n

+ Ch\u1ea3y m\u00e1u l\u1ee3i.<\/p>\n

+ Rong kinh.<\/p>\n

T\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 v\u00e0 v\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft, c\u00e1c bi\u1ec7n ph\u00e1p x\u1eed tr\u00ed bao g\u1ed3m:<\/p>\n

+ Ng\u1eebng d\u00f9ng thu\u1ed1c ngay ho\u1eb7c gi\u1ea3m li\u1ec1u, d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 m\u1ea5t m\u00e1u v\u00e0 m\u1ee9c \u0111\u1ed9 nguy c\u01a1 khi kh\u00f4ng th\u1ec3 ti\u1ebfp t\u1ee5c d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng.<\/p>\n

+ Truy\u1ec1n m\u00e1u.<\/p>\n

+ D\u00f9ng protamin sulfat v\u1edbi t\u00e1c d\u1ee5ng gi\u1ea3i \u0111\u1ed9c, do protamin trung h\u00f2a t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng c\u1ee7a heparin b\u1eb1ng c\u00e1ch li\u00ean k\u1ebft v\u1edbi thu\u1ed1c, ph\u00e1 h\u1ee7y ph\u1ee9c h\u1ee3p
\nheparin-antithrombin. Li\u1ec1u c\u1ee7a protamin \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a tr\u00ean li\u1ec1u heparin \u0111\u00e3 d\u00f9ng tr\u01b0\u1edbc \u0111\u00f3, c\u00f3 t\u00ednh \u0111\u1ebfn th\u1eddi gian b\u00e1n th\u1ea3i, d\u1ef1a tr\u00ean c\u01a1 s\u1edf 1 mg protamin c\u00f3 th\u1ec3 trung h\u00f2a 100 IU heparin.<\/p>\n

– D\u1ea5u hi\u1ec7u tr\u00ean da:<\/em>\u00a0c\u1ea7n theo d\u00f5i v\u1ecb tr\u00ed ti\u00eam do c\u00f3 th\u1ec3 x\u1ea3y ra d\u1ecb \u1ee9ng v\u1edbi heparin ho\u1eb7c m\u1ed9t trong nh\u1eefng th\u00e0nh ph\u1ea7n c\u1ee7a thu\u1ed1c. Th\u00eam v\u00e0o \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u1ea7n ch\u00fa \u00fd theo d\u00f5i h\u00e0ng ng\u00e0y \u0111\u1ec3 t\u00ecm ra nh\u1eefng v\u1ebft b\u1ea7m t\u00edm ho\u1eb7c nh\u1eefng d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng tr\u00ean da.<\/p>\n

– Khi \u0111i du l\u1ecbch:\u00a0<\/em>t\u1ea5t c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 tr\u1ea3i qua m\u1ed9t bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i n\u1eb7ng c\u1ea7n \u0111\u01b0\u1ee3c kh\u00e1m c\u1ea9n th\u1eadn tr\u01b0\u1edbc nh\u1eefng chuy\u1ebfn \u0111i d\u00e0i (tr\u00ean 4 gi\u1edd), k\u1ec3 c\u1ea3 b\u1eb1ng \u0111\u01b0\u1eddng h\u00e0ng kh\u00f4ng hay \u0111\u01b0\u1eddng b\u1ed9. S\u1ef1 thay \u0111\u1ed5i v\u1ec1 \u00e1p su\u1ea5t ho\u1eb7c \u1ee9 tr\u1ec7 tu\u1ea7n ho\u00e0n k\u00e9o d\u00e0i do ng\u1ed3i l\u00e2u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nguy c\u01a1 huy\u1ebft kh\u1ed1i. \u0110\u1ec3 d\u1ef1 ph\u00f2ng, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng b\u0103ng \u00e9p t\u0129nh m\u1ea1ch v\u00e0 ti\u00eam m\u1ed9t li\u1ec1u heparin KLPTT 2 gi\u1edd tr\u01b0\u1edbc khi kh\u1edfi h\u00e0nh (chu\u1ea9n b\u1ecb tr\u01b0\u1edbc m\u0169i ti\u00eam l\u1ea7n 2 khi quay v\u1ec1). Trong tr\u01b0\u1eddng h\u1ee3p \u0111i m\u00e1y bay, b\u1ec7nh nh\u00e2n c\u1ea7n mang theo heparin v\u00e0 \u0111\u01a1n thu\u1ed1c (b\u1eb1ng ti\u1ebfng Anh ho\u1eb7c d\u1ecbch sang ng\u00f4n ng\u1eef c\u1ee7a n\u01b0\u1edbc s\u1eafp \u0111\u1ebfn). T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, c\u1ea7n h\u1ecfi k\u0129 th\u00f4ng tin \u0111\u1ec3 bi\u1ebft \u0111\u01b0\u1ee3c n\u01a1i \u0111\u1ebfn trong tr\u01b0\u1eddng h\u1ee3p x\u1ea3y ra v\u1ea5n \u0111\u1ec1 v\u1ec1 s\u1ee9c kh\u1ecfe t\u1ea1i n\u01a1i \u0111\u00f3.<\/p>\n

– S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n:<\/em>\u00a0kh\u00f4ng n\u00ean d\u00f9ng thu\u1ed1c \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c NSAIDs, c\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c nh\u01b0 paracetamol. N\u1ebfu b\u1eaft bu\u1ed9c ph\u1ea3i d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi m\u1ed9t NSAID, c\u1ea7n ph\u1ea3i theo d\u00f5i l\u00e2m s\u00e0ng r\u1ea5t nghi\u00eam ng\u1eb7t.<\/p>\n","protected":false},"excerpt":{"rendered":"

Theo Canhgiacduoc S\u1eec D\u1ee4NG H\u1ee2P L\u00dd, AN TO\u00c0N C\u00c1C HEPARIN KH\u1ed0I L\u01af\u1ee2NG PH\u00c2N T\u1eec TH\u1ea4P \u00a0Nguy\u1ec5n Duy H\u01b0ng, Ho\u00e0ng H\u00e0 Ph\u01b0\u01a1ng T\u00f3m t\u1eaft Heparin l\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam. Trong khi heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n t\u00e1c d\u1ee5ng tr\u00ean y\u1ebfu t\u1ed1 IIa v\u00e0 Xa th\u00ec heparin kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (KLPTT) v\u00e0 fondaparinux […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[373],"tags":[],"class_list":["post-11183","post","type-post","status-publish","format-standard","hentry","category-duoc-lam-sang"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11183","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=11183"}],"version-history":[{"count":1,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11183\/revisions"}],"predecessor-version":[{"id":11185,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11183\/revisions\/11185"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=11183"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=11183"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=11183"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}