低分子量肝素Low-Molecular-Weight Heparins(LMWH) :
Enoxaparin (Clexane)
藥理作用:
LMWHs 為低分子量肝素的片段結構,分子量小,已分離出其標準肝素的抗血栓及抗凝血作用。Enoxaparin為低分子量肝素,主要抑制 factor Xa,次要抑制 factor 9, 11, 12。Enoxaparin以anti-Xa來標定的活性比anti-IIa或抗血栓活性(antithrombin activity)強。
使用劑量:
1、1 mg/kg SC/IV Q12H。皮下(SC)或IV靜推。勿打IM。
2、最高投與劑量:75mg SC, q12h.
3、不須監測apTT,但要注意血小板低下。
4、以低分子量肝素治療之療程不應超過10天,包括給與維生素K拮抗劑達到穩定時所需的時間,除非病患無法改用口服抗凝血劑,否則應儘早改用口服凝抗血劑。
注意事項:
腎功能不全,應調整劑量,eGFR<30 ml,劑量減半,否則容易出血。或改用Heparin
肥胖(BMI>40), 或體重過輕(Male< 57kg, Female< 45kg)
臨床治療:
1.深部靜脈栓塞(DVT):
預防:40mg SC QD
治療:1mg/kg SC Q12H或1.5mg/kg QD
*DVT treatment Guideline: European Heart Journal (2020) 41, 543-603)
2.急性冠心症(ACS)
給予PCI治療時,配合使用。劑量0.5 mg/kg i.v. bolus.
*2020 ACS ESC Guideline European Heart Journal (2020) 00, 1-79
LMWH禁忌
1、對enoxaparin過敏;
2、具有因傳統肝素(unfractionated heparin)或低分子量肝素引發嚴重的第Ⅱ型肝素引發血小減少症(HIT)之病史者;
3、出血症狀或止血障礙傾向(當此狀況與使用肝素無關時,可能之例外的情形是散佈性血管內凝血);
4、器官病變,容易出血;
5、顱內出血;
6、以低分子量肝素作治療之期間,不可進行硬模外或脊椎管內麻醉。
#健保給付規定
Enoxaparin 注射劑(如Clexane):(108/2/1)
依下列情形使用:
1. 治療深部靜脈栓塞(DVT):每次療程使用小於10天。
2. 治療急性冠心症(ACS):每次療程使用60mg 1天2次,2~8天。
3. 預防手術後靜脈栓塞:腹部手術,每次療程使用40mg 1天1次,7~10天;膝蓋或髖關節手
術,每次療程使用30mg 1天1次,7~10天。
注意事項
1、Enoxaparin與傳統Heparin或其他低分子量Heparins,不能直接以unit對unit的方式交替使用。
過量處理
2、皮下注射大量低分子量肝素後之意外過量會發生出血併發症。
3、發生出血時,某些案例可能適用protamine sulfate作治療,要牢記下述:
1.未分斷肝素較無效。
2.由於不良反應(特別是過敏性休克),開立該處方前要評估protamine sulfate之利益/危險比。緩慢靜脈注射protamine(sulfate或hydrochloride)可達到中和的效果。
Protamine的劑量依下列情況而定:
1.肝素注射量(100 anti-heparin單位的 protamine中和100 anti-Xa IU的低分子量肝素的活性)
2.施打肝素後隨著時間的消逝,要適當地減少解毒劑的劑量。然而,enoxaparin之anti-Xa activity無法完全被中和掉,而且,由於低分子量肝素之吸收動力學,這種中和可能只是暫時性的。這種情形下,可能需要將protamine的總劑量於24小時內分成數次注射(2至4次)。
Heparin類似藥物:
Hirudin:由水蛭抽提出之胜肽,已有合成製劑靜脈注射,直接抑制凝血酶活性,抗凝血作用較 Heparin 更直接,專一性且藥效強。
Dextran sulfate:作用與Heparin 相似,但作用時間長,治療腦血管栓塞症。
#Heparin
#Protamine
#Warfarin
#LMWH
#INR
#Clexane
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
clexane 在 Facebook 的最佳貼文
抗凝血藥物Heparin & Warfarin
Heparin的使用劑量
Heparin注射過量時的解毒劑~~
ICU 常用的低分子量肝素Low-Molecular-Weight Heparins(LMWH) : Enoxaparin (Clexane)
老藥Warfarin,還記得哪些?
Warfarin overdose或 INR超標如何處置?
繼續閱讀~~
#INR #Warfarin #Coumadin #PCC
#FFP
#vit_K
#抗凝劑
clexane 在 9bulan10hari Facebook 的最佳解答
Waktu mengandung puas dah kena cucuk sana cucuk sini.. lepas bersalin pun kena cucuk lagi? Kena ambil 20 suntikan? Pitam jap dengar.
Kenapa kena cucuk HEPARIN lepas bersalin? Apa tu heparin?
Suntikan heparin ni ubat cairkan darah, ia bertujuan utk elakkan darah beku yg amat bahaya utk ibu2 lepas bersalin.
Biasanya orang yg bersalin czer kena amik suntikan ni tapi sekarang ni yg normal pun ada yang kena atas sebab-sebab berikut:
1. Usia ibu yang semakin tua (35 tahun ke atas)
2. Berat badan obes
3. Merokok
4. Kehamilan kembar
5. Ada masalah lain (seperti pre-eklampsia, penyakit jantung lemah)
6. Kekurangan pergerakan badan (seperti selepas pembedahan caesarean)
7. Kekurangan meminum air (dehidrasi)
8. Tumpah darah berlebihan ketika bersalin.
Untuk ibu yang beranak Caesar, biasanya suntikan 2 kali sehari selama 10 hari . Suka atau tidak, demi kesihatan ibu, kenalah bawa ubat yg dibekalkan dari Hospital ke klinik kesihatan berhampiran utk menerima suntikan 8 pagi dan 8 malam.
Nampak macam menyusahkan kan? Dengan nak keadaan masih sakit-sakit, nak bawa baby check up lagi, kena pula pergi klinik.
Tapi ada juga ibu yang boleh injet sendiri di rumah tapi perlu disiplin. Ubat cair darah ni nampak renyah, tapi ianya sangat PENTING!
Ini untuk mengelakkan ibu diserang pembekuan darah dalam saluran darah paru-paru (Pulmonary Embolism).
Jangan ambil mudah ya mommy, darah beku dlm salur darah boleh menggangu darah utk mengalir ke paru-paru dan menghalang oksigen masuk secukupnya dlm darah.
Ianya boleh membawa kepada kematian mengejut. Nauzubillah!
Jadi, apa perlu mommy buat lepas bersalin?
1) Rehat secukupnya dan jangan stress.
2) Minum air secukupnya, jangan sampai dehidrasi.
3) Sentiasa aktif bergerak tanpa melakukan kerja berat.
Heparin ni ada 2 jenis :
1) Ada unsur khinzir ( inject 1x sehari)
2) Tak ada unsur khinzir ( inject 2x sehari)
Mungkin ada mommy yang risau dan khuatir, sebab ubat suntikan pencair darah seperti clexane itu berunsur khinzir.
Kenapa diharuskan mengambil clexane walaupun ada unsur khinzir?
1. Tidak ada ubat lain yang tidak berunsur khinzir yang lebih baik daripada clexane.
2. Ubat suntikan heparin tidak memberi keberkesanan setanding dengan clexane terutama untuk ibu yang berat badan lebih 90kg.
3. Ubat fondaparinux pula sangat mahal dan ramai ibu tidak mampu. Ia boleh memasuki susu badan dan bayi yang menyusu boleh mendapat dos yang sedikit.
Don’t worry mommy, dengar cakap doktor apa jua yg terbaik buat anda. Fikir yang baik-baik ya dan jaga kesihatan!
When you're pregnant, you've been stabbed and stabbed here.. after giving birth you'll be stabbed again? Gotta take 20 shots? I'll be blown out listening to it.
Why got poked by HEPARIN off maternity? What is heparin?
This heparin injection is medicine to reduce blood, it is meant to avoid frozen blood that is very dangerous for mothers after giving birth.
Usually people who maternity czer get amiked by this shot but now the normal one will be hit by the following causes:
1. Mom's age is getting older (35 years and above)
2. Obese weight
3. Smoking
4. Twin pregnancy
5. There are other issues (like pre-eclampsia, heart disease is weak)
6. Lack of body movement (like after caesarean surgery)
7. Lack of drinking water (dehydration)
8. Excessive blood spilled during delivery.
For Caesar mothers, usually injections 2 times a day for 10 days. Like it or not, for the sake of mother's health, need to bring the medicine provided from Hospital to the nearby health clinic to receive injections from 8 am and 8 pm.
Looks like a trouble right? With the sick condition, want to bring the baby to check up again, have to go to the clinic.
But there are also mothers who can injet themselves at home but need discipline. This bloody medicine looks crunchy, but it's very IMPORTANT!
This is to prevent mother from being attacked by blood freezing in the lung blood channel (Pulmonary Embolism).
Don't take it easy, mommy, frozen blood in the blood vessels can disturb blood to flow into the lungs and prevent oxygen from entering enough blood.
It can lead to a sudden death. \ Cannot translate \
So, what should mommy do after giving birth?
1) Rest enough and don't stress.
2) Drink enough water, don't get hydrated.
3) Always actively moving without doing heavy work.
There are 2 types of Heparin:
1) There are pig elements (inject 1 x a day)
2) No pig elements (inject 2 x a day)
Maybe there's a mommy who's worried and worried, because the blood melting injections like clexane are pigs.
Why is it necessary to take clexane even though there is a pig element?
1. There is no other medicine that is better than clexane.
2. Heparin injection medicine doesn't give effectiveness comparable to clexane especially for mothers who weigh over 90 kg.
3. Fondaparinux medicine is very expensive and many mothers can't afford it. It can enter body milk and breastfeeding babies can get a little dose.
Don't worry mommy, listen to whatever doctor is the best for you. Think carefully and take care of your health!Translated
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