Yini i-Bivalirudin: Ukusetshenziswa, Umthamo, Imiphumela Eceleni Nokunye

I-Bivalirudin iyikhambi elinamandla lokunciphisa igazi elinikezwa nge-IV ngesikhathi sezinqubo ezithile zenhliziyo nokuhlinzwa. Le anticoagulant eyenziwe ngamachiza isebenza ngokuvimbela ukwakheka kwamahlule egazi lapho uhlelo lwakho lwemvelo lokujiya kwegazi luba ngaphezu kwamandla ngesikhathi sokungenelela kwezokwelapha.

Uma udokotela wakho ekhulume nge-bivalirudin ngenqubo ezayo, cishe ubhekene nesimo lapho ukunciphisa igazi okunembile kubalulekile ekuphepheni kwakho. Ukuqonda ukuthi le mithi isebenza kanjani nokuthi yini ongayilindela kungakusiza uzizwe ulungiseleleke futhi uqiniseke ngokunakekelwa kwakho.

Yini i-Bivalirudin?

I-Bivalirudin iyikhambi elenziwe ngamachiza elilingisa iphrotheni yemvelo ebizwa nge-hirudin, ekuqaleni etholakala eminywaneni yezokwelapha. Yenzelwe ngqo ukusetshenziswa esibhedlela ngesikhathi sezinqubo lapho ukujiya kwegazi kudingeka kulawulwe ngokucophelela.

Le mithi ingeyeqembu elibizwa ngokuthi ama-inhibitors e-thrombin aqondile, okusho ukuthi ivimba iphrotheni ebalulekile ekujiyeni kwegazi lakho. Ngokungafani neminye imithi yokunciphisa igazi ongayithatha ekhaya, i-bivalirudin isebenza ngokushesha futhi inesikhathi esifushane sokusebenza, okuyenza ilungele izilungiselelo zezokwelapha ezilawulwayo.

Imithi ihlale inikezwa ngomthambo ngabasebenzi bezempilo abaqeqeshiwe. Ngeke nanini uyiphathise le mithi ngokwakho, njengoba idinga ukulinganiswa okunembile nokuqapha okuqhubekayo kuyo yonke inqubo yakho.

Isetshenziselwani i-Bivalirudin?

I-Bivalirudin isetshenziswa ikakhulukazi ngesikhathi sezinqubo ze-percutaneous coronary interventions, ezivame ukwaziwa ngokuthi i-angioplasty noma izinqubo zokufaka ikhathetha enhliziyweni. Lezi izinqubo ezingahlaseli kakhulu lapho odokotela bevula imithambo evaliwe enhliziyweni yakho besebenzisa amabhaluni amancane nama-stents.

Ngesikhathi salezi zinqubo, igazi lakho lithintana namadivayisi ezokwelapha namashubhu e-catheter, okungase kubangele ukugcwala okungafuneki. I-Bivalirudin ivimbela lezi zixhobo eziyingozi ukuthi zingakheki ngenkathi ivumela ithimba lakho lezokwelapha ukuthi lisebenze ngokuphepha emithanjeni yegazi yenhliziyo yakho.

Lo muthi usetshenziswa futhi ngesikhathi sokuhlinzwa okuthile kwenhliziyo, ikakhulukazi lapho iziguli zingakwazi ukuthola i-heparin ngenxa yokungezwani komzimba noma isimo esibizwa ngokuthi i-heparin-induced thrombocytopenia. Kulezi zimo, i-bivalirudin inikeza enye indlela ephephile yokulwa nokugcwala kwegazi ngesikhathi sokuhlinzwa.

Ezinye izibhedlela zisebenzisa i-bivalirudin ezigulini ezenziwa izinqubo eziphuthumayo zenhliziyo, njengoba ingaqalwa ngokushesha ngaphandle kokuhlolwa kwegazi okukhulu. Lokhu kuyenza ibaluleke lapho isikhathi sibalulekile ekubuyiseleni ukuhamba kwegazi enhliziyweni yakho.

Isebenza Kanjani I-Bivalirudin?

I-Bivalirudin isebenza ngokuvimba ngokuqondile i-thrombin, iphrotheni ebalulekile esiza ukwakha amahlule egazi. Cabanga nge-thrombin njengoshintsho oluyinhloko oluguqula igazi eliwuketshezi libe yihlule eliqinile uma ulimele.

Lo muthi uthathwa njengomuthi oqinile ngokuphakathi phakathi kwabanciphisi begazi, kodwa okwenza ukuthi kube okukhethekile ukunemba kwawo nokubuyiseka. Ibopha ngokuqondile kuma-molecule e-thrombin, iwavimbela ukuthi angaguquli i-fibrinogen ibe yi-fibrin, imicu yamaprotheni enza amahlule angempela.

Imiphumela yomuthi cishe iyashesha uma ingena egazini lakho. Ngemizuzu, ikhono legazi lakho lokugcwala liyehliswa kakhulu, okuyilokho kanye okudingekayo ngesikhathi sezinqubo zenhliziyo.

Okwenza uqiniseke nge-bivalirudin ukuthi inesigamu sokuphila esifushane kakhulu, okusho ukuthi isusa ngokushesha ohlelweni lwakho. Uma i-IV imisiwe, imiphumela yomuthi ngokuvamile iyaphela phakathi kwehora elingu-1-2, okwenza ikhono lakho elijwayelekile lokugcwala libuyele.

Kufanele Ngiyithathe Kanjani I-Bivalirudin?

Ngeke uzithathele wena i-bivalirudin, njengoba inikezwa kuphela ochwepheshe bezempilo ezindaweni zase-hospital. Umuthi unikezwa ngomugqa we-IV, kungaba njengomjovo osheshayo olandelwa yiconsi eliqhubekayo, noma njengokumpontshwa okuqhubekayo kuyo yonke inqubo yakho.

Ithimba lakho lezokwelapha lizobala umthamo oqondile ngokusekelwe esisindweni sakho, ukusebenza kwezinso, kanye nenqubo ethile oyenzayo. Bazogada impendulo yakho ngokucophelela futhi balungise umthamo uma kudingeka ukuze kugcinwe izinga elifanele lokunciphisa igazi.

Ngaphambi kokuthola i-bivalirudin, ngokuvamile uzocelwa ukuthi ugweme ukudla noma ukuphuza amahora amaningana, njengoba ungakwenza ngaphambi kwanoma iyiphi inqubo edinga ukuthuliswa. Ithimba lakho lezempilo lizokunikeza imiyalelo ethile mayelana nokuthi uyeke nini ukudla nokuphuza.

Umuthi awudingi noma yikuphi ukulungiswa okukhethekile ngakini mayelana nokudla noma eminye imithi, nakuba kufanele ngaso sonke isikhathi wazise ithimba lakho lezokwelapha ngayo yonke imithi kanye nezithasiselo ozithathayo. Bazohlela konke ukuze baqinisekise ukuphepha kwakho ngesikhathi senqubo.

Kufanele Ngiyithathe Isikhathi Esingakanani I-Bivalirudin?

I-Bivalirudin isetshenziswa kuphela ngesikhathi senqubo yakho kanye nesikhathi esifushane ngemva kwalokho, ngokuvamile kusukela kumaminithi angu-30 kuya emahoreni amaningana. Isikhathi esiqondile sincike ekutheni inqubo yakho iyinkimbinkimbi kangakanani nokuthi umzimba wakho usabela kanjani emuthini.

Ezinhlobonhlobo zezinqubo zokufaka ikhathetha yenhliziyo, uzothola i-bivalirudin ngesikhathi senqubo kanye nemizuzu eyengeziwe engu-30 kuya emahoreni angu-4 ngemva kwalokho. Lokhu kuqinisekisa ukuthi igazi lakho lihlala licheke kahle ngenkathi noma yiziphi izingozi ezihlobene nenqubo ziphakeme kakhulu.

Ithimba lakho lezokwelapha lizinquma ukuthi liyeke nini umuthi ngokusekelwe ezintweni eziningana, okuhlanganisa ukuthi inqubo yakho ihambe kahle kangakanani, ukuthi ngabe uhlangabezane nokopha, nokuthi umzimba wakho udinga ngokushesha kangakanani ukubuyela ekusebenzeni okuvamile kokujiya kwegazi.

Uma i-bivalirudin iyekisiwe, ngeke kudingeke ukhathazeke ngokuyithatha ekhaya. Kodwa-ke, udokotela wakho angase anikeze eminye imithi yokunciphisa igazi ukuze isetshenziswe isikhathi eside, kuye ngesimo senhliziyo yakho esithile nezidingo zokwelashwa eziqhubekayo.

Yiziphi Izimo Ezingezinhle Ze-Bivalirudin?

Njengayo yonke imithi yokunciphisa igazi, umphumela omkhulu we-bivalirudin ukwanda kwengozi yokopha. Lokhu empeleni imithi esebenza njengoba ihloswe, kodwa idinga ukuqashwa ngokucophelela yithimba lakho lezempilo.

Iziguli eziningi zithola kuphela imiphumela emincane engemihle, uma ikhona. Imithi ivame ukubekezelelwa kahle ngoba isetshenziselwa izikhathi ezimfushane ngaphansi kokugadwa kwezokwelapha okuseduze.

Nawa amanye imiphumela ejwayelekile ongase uyithole ngesikhathi noma ngemva nje kokuthola i-bivalirudin:

• Ukuphuma kwegazi okuncane endaweni ye-IV noma indawo yokufaka i-catheter
• Amaqhubu amancane lapho kufakwe khona amadivayisi ezokwelapha
• Ukwehla okuncane kwengcindezi yegazi
• Ukucasuka okuncane, nakuba lokhu kuvame ukuhlobana nenqubo uqobo
• Ubuhlungu obungamanye emuva ngesikhathi sezinqubo ezinde

Le miphumela ivame ukuba mncane futhi ixazululwe ngokushesha uma imithi imisiwe futhi inqubo yakho isiqediwe.

Imiphumela emibi kakhulu ayivamile kodwa idinga ukunakekelwa kwezokwelapha ngokushesha. Ithimba lakho lezempilo liqapha lokhu ngokucophelela:

• Ukuphuma kwegazi okukhulu okungami ngengcindezi
• Ukuphuma kwegazi ebuchosheni, nakuba lokhu kungavamile kakhulu
• Ukuphendula okukhulu komzimba okunezingxaki zokuphefumula noma ukuvuvukala
• Ukwehla okuyingozi kwengcindezi yegazi
• Ukuphuma kwegazi emathunjini okugaya noma kwamanye amalungu angaphakathi

Izindaba ezinhle ukuthi ithimba lakho lezokwelapha liqeqeshwe ukubona nokwelapha lezi zinkinga ngokushesha. Banemithi nezinqubo ezilungele ukuguqula imiphumela ye-bivalirudin uma kudingeka.

Ubani Ongafanele Athole I-Bivalirudin?

I-Bivalirudin ngokuvamile iphephe kakhulu kunezinye izidakamizwa ezinciphisa igazi, kodwa ayifanele wonke umuntu. Ithimba lakho lezokwelapha lizohlola ngokucophelela umlando wakho wezempilo ngaphambi kokunquma ukuthi lo muthi ukufanele yini.

Akufanele uthole i-bivalirudin uma unokuphuma kwegazi okusebenzayo, okungalawuleki noma yikuphi emzimbeni wakho. Lokhu kufaka phakathi ukuhlinzwa kwakamuva ngokuqhubeka nokuphuma kwegazi, izilonda ezisebenzayo, noma noma yisiphi isimo esibangela ukuphuma kwegazi kwangaphakathi.

Abantu abanezifo ezinzima zezinso bangase badinge ukulungiswa komthamo noma eminye imithi, njengoba i-bivalirudin ikhishwa kancane ngezinso. Udokotela wakho uzohlola ukusebenza kwezinso zakho ngaphambi nangemva kokwelashwa.

Ezinye izimo ezingavamile zenza i-bivalirudin ingafaneleki kangako. Lokhu kufaka phakathi isifo esinzima sesibindi, unhlangothi lwakamuva, noma izifo zegazi ezithinta ukujiya kwegazi. Ithimba lakho lezokwelapha lizohlola lezi zingozi ngokumelene nezinzuzo zenqubo yakho ehleliwe.

Ukukhulelwa kudinga ukucatshangelwa okukhethekile, nakuba i-bivalirudin ingasetshenziswa uma izinzuzo zidlula izingozi. Udokotela wakho uzoxoxa lokhu ngokucophelela uma ukhulelwe noma ungase ukhulelwe.

Amagama Omkhiqizo we-Bivalirudin

I-Bivalirudin yaziwa kakhulu ngegama layo lomkhiqizo i-Angiomax e-United States. Lena inguqulo ongase uhlangane nayo uma wenza inqubo esibhedlela saseMelika.

Lo muthi ungase futhi utholakale ngaphansi kwamanye amagama omkhiqizo emazweni ahlukene, kodwa isithako esisebenzayo nemiphumela kuhlala kufana. Ithimba lakho lezempilo lizosebenzisa noma iyiphi inguqulo etholakala esibhedlela sakho.

Ezinye izibhedlela zingase zibhekisele kuyo ngokuthi

Eminye imithi eminingi inganikeza imiphumela efanayo yokunciphisa igazi ngesikhathi senqubo, nakuba ngayinye inezinzuzo ezihlukene kanye nezinto okufanele zicatshangelwe. Udokotela wakho uzokhetha inketho engcono kakhulu ngokusekelwe esimweni sakho esithile.

I-Heparin iyindlela endala kakhulu futhi isasetshenziswa kakhulu ngesikhathi sezinqubo zenhliziyo. Isetshenziswe ngokuphepha amashumi eminyaka futhi ayibizi njenge-bivalirudin, kodwa idinga ukuhlolwa kwegazi nokugadwa okuvamile.

I-Enoxaparin (Lovenox) enye inketho, ikakhulukazi ezigulini ezidinga ukunciphisa igazi ngaphambi nangemva kwezinqubo. Inikezwa njengesitsha ngaphansi kwesikhumba kunokuba nge-IV.

Ezigulini ezinokungezwani ne-heparin, ezinye izithiyo eziqondile ze-thrombin njenge-argatroban zingase zisetshenziswe. Lezi zisebenza ngendlela efanayo ne-bivalirudin kodwa zingase zibe nezidingo ezihlukene zokulinganisa noma amaphrofayili emiphumela emibi.

Ithimba lakho lezokwelapha lizocabangela izinto ezinjengomsebenzi wakho wezinso, ingozi yokopha, uhlobo lwenqubo, kanye nanoma yikuphi ukungezwani komuthi lapho ukhetha i-anticoagulant engcono kakhulu esimweni sakho.

Ingabe i-Bivalirudin Ingcono Kune-Heparin?

Kokubili i-bivalirudin ne-heparin ziyizinciphisi zegazi ezinhle kakhulu, kodwa zinamandla ahlukene okwenza ngamunye afaneleke kangcono ezimweni ezihlukene. Akukho noyedwa ongcono kunomunye.

I-Bivalirudin inikeza ukunciphisa igazi okungaphezu kokulindelekile ngaphandle kokudinga ukuhlolwa kwegazi okuvamile ngesikhathi senqubo yakho. Lokhu kungenza izinqubo zihambe kahle futhi kunganciphisa ingozi yezinkinga ezithile.

Umuthi ungase ubangele ukopha okuncane kune-heparin ezigulini ezithile, ikakhulukazi lezo ezenza izinqubo eziyinkimbinkimbi. Futhi akudingi umuthi owengeziwe ukuze uguqule imiphumela yawo, njengoba isusa ohlelweni lwakho ngokwemvelo.

Nokho, i-heparin isetshenziswe ngokuphepha isikhathi eside futhi ibiza kakhulu kune-bivalirudin. Izibhedlela eziningi zinolwazi oluningi nge-heparin futhi zinezimiso ezinhle zokusetshenziswa kwayo.

Iqembu lakho lezokwelapha lizokhetha ngokusekelwe ezingozini zakho ngazinye, inqubo ethile oyenzayo, nokuthi yini esebenze kahle kakhulu ngokuhlangenwe nakho kwabo. Yomibili imithi isebenza kahle kakhulu uma isetshenziswa ngendlela efanele.

Imibuzo Evame Ukubuzwa Mayelana ne-Bivalirudin

Ingabe i-Bivalirudin iphephile kubantu abanezifo zezinso?

I-Bivalirudin ingasetshenziswa kubantu abanezifo zezinso, kodwa idinga ukulungiswa kwemithamo ngokucophelela. Njengoba cishe u-20% womuthi uqedwa ngezinsini zakho, ukuncipha komsebenzi wezinso kusho ukuthi umuthi uhlala esistemini yakho isikhathi eside.

Iqembu lakho lezokwelapha lizohlola ukusebenza kwezinso zakho ngaphambi kokukunika i-bivalirudin futhi linganciphisa umthamo ngokufanele. Bazokuqapha eduze ngesikhathi nangemva kwenqubo yakho ukuze baqinisekise ukuthi umuthi usebenza kahle ngaphandle kokubangela ukuphuma kwegazi okukhulu.

Kubantu abanezifo ezinzima zezinso noma labo abase-dialysis, i-bivalirudin ingase ikhethwe ngaphezu kwe-heparin kwezinye izimo, njengoba kungenzeka kancane ukuthi ibangele izinkinga ezithile.

Ngingenzani uma ngithola i-Bivalirudin eningi ngengozi?

Ngeke uzisingathele wena i-bivalirudin, njengoba inikezwa kuphela ochwepheshe bezempilo ezibhedlela. Uma kuningi okunikwe ngengozi, iqembu lakho lezokwelapha lizobona lokhu ngokushesha ngokusebenzisa ukuqapha futhi lithathe isinyathelo esisheshayo.

Okukhathaza kakhulu nge-bivalirudin eningi ukuphuma kwegazi okukhulu. Ithimba lakho lezempilo lizoyeka umuthi ngokushesha futhi lingakunika imithi yokusiza igazi lakho ukuba liqine ngokuphinde.

Bangase futhi bakunike imikhiqizo yegazi uma kudingeka futhi bazokuqapha eduze kuze kube yilapho umsebenzi wakho wokuqina ubuya kokujwayelekile. Ngenxa yokuthi i-bivalirudin isuka ngokushesha esistemini yakho, imiphumela eminingi izoxazululwa emahoreni ambalwa.

Kwenzekani uma umthamo we-Bivalirudin uphuthelwa ngesikhathi senqubo yami?

Iqembu lakho lezokwelapha liqapha ngokucophelela amazinga akho e-bivalirudin kuyo yonke inqubo yakho, ngakho-ke amathuba okuthi imithamo ingaphuthelwa mancane kakhulu. Umuthi unikezwa njengokufakwa okuqhubekayo, okusho ukuthi ungena ngokuqhubekayo emsingeni wakho wegazi.

Uma kwenzeka ukuphazamiseka ekufakweni, iqembu lakho lezempilo lingabona ngokushesha ngemishini yokuqapha nokuhlolwa kwegazi. Bazophinda baqale umuthi ngokushesha ukuze bagcine ukuncipha kwegazi okufanele.

Isikhathi esifushane semiphumela ye-bivalirudin sichaza ukuthi ngisho nokuphazamiseka okufushane kungathinta ukuphepha kwenqubo yakho, ngakho-ke iqembu lakho lezokwelapha linakekela kakhulu ukuqinisekisa ukuthi umthamo uqhubekayo, ofanele.

Ngingayeka nini ukuthatha i-Bivalirudin?

Ngeke wenze isinqumo sokuyeka i-bivalirudin ngokwakho, njengoba lo muthi usetshenziswa kuphela ezindaweni zasemtholampilo ngaphansi kokuqashwa kwezokwelapha. Ithimba lakho lezempilo lizinqumela isikhathi esifanele sokuyeka ngokusekelwe ekuqedenini kwenqubo yakho nentuthuko yakho yokululama.

Ngokuvamile, i-bivalirudin iyekwa lapho inqubo yakho isiqediwe futhi noma yiziphi izingozi ezisheshayo zidlulile. Lokhu kungase kube ngemva nje kwenqubo noma ngemva kwamahora amaningana, kuye ngesimo sakho esithile.

Iqembu lakho lezokwelapha lizoqinisekisa ukuthi kuphephile ukuyeka umuthi ngokuhlola ukuthi awukho engozini yamaqhubu egazi nokuthi noma yikuphi ukopha okuhlobene nenqubo kulawulwe. Bazokuqapha eduze njengoba imiphumela yomuthi iphela.

Ngingashayela ngemva kokuthola i-Bivalirudin?

Akufanele ushayele ngemva nje kokuthola i-bivalirudin, kodwa lokhu kuvamile ngenxa yenqubo yakho yezokwelapha kunomuthi ngokwawo. Izinqubo eziningi ezidinga i-bivalirudin zihlanganisa nokuthulisa noma zenzeke ezimweni lapho udinga isikhathi sokululama.

Umuthi ngokwawo awuthinti ngokuqondile ikhono lakho lokushayela, kodwa ungase uzizwe ukhathele noma ubuthakathaka ngenxa yenqubo yakho. Ithimba lakho lezempilo lizokunikeza imiyalelo ethile mayelana nokuthi kuphephile nini ukuqhubeka nemisebenzi ejwayelekile, okuhlanganisa nokushayela.

Ngokuvamile, uzodinga umuntu ozokushayela ekhaya ngemva kwanoma iyiphi inqubo ebandakanya i-bivalirudin. Hlela ukuhlela ezokuthutha kusengaphambili, njengoba ungase ungazizwa ukulungele ukushayela amahora amaningi noma ngisho nosuku ngemva kwenqubo yakho.