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Warfarin

I-Warfarin ingenye yemithi elwa ne-anticoagulant echazwe kabanzi emhlabeni wonke. Lo muthi obalulekile usiza ukuvimbela amahlule egazi ayingozi angaholela ezinkingeni ezingase zibe yingozi empilweni (ukushaywa unhlangothi, ukushaya kwenhliziyo, noma i-deep vein thrombosis). Lo mhlahlandlela obanzi uhlola konke iziguli okudingeka zazi ngamaphilisi e-Warfarin, okuhlanganisa nokuphathwa kwawo okufanele, imiphumela engemihle engase ibe khona, izinyathelo zokuphepha ezidingekayo, kanye nokucatshangelwa kokudla okubalulekile. 

Iyini i-Warfarin?

Eyasungulwa ekuqaleni njengoshevu wamagundane ngo-1948, i-warfarin isiguquke yaba umuthi obalulekile we-anticoagulant emithini yesimanje. Naphezu kokuba ngokuvamile kucatshangwa ukuthi inciphisa igazi, i-warfarin yethebhu ayilizaci igazi kodwa kunalokho ivimbela ukukhula kwamahlule egazi ngokuphazamisa indlela igazi elijiyisa ngayo.

Itholakala ngamandla ahlukahlukene amathebulethi asukela ku-1mg kuya ku-10mg, i-warfarin idinga ukuqapha ngokucophelela ngokuhlolwa kwegazi okujwayelekile okubizwa ngokuthi amasheke we-prothrombin time (INR).
Ukubaluleka kwe-Warfarin ekwelashweni kubonakala ngokufakwa kwayo ohlwini Lwemithi Ebalulekile Yenhlangano Yezempilo Yezwe. 

shayela nathi
bhuka i-aphoyintimenti

Ukusetshenziswa kwethebhulethi ye-Warfarin

Umuthi usebenza kokubili izinjongo zokuvimbela kanye zokwelapha ekulawuleni izimo ezinzima zenhliziyo nemithambo yegazi.

Ukusetshenziswa okuyinhloko kwe-Warfarin:

Odokotela bangase futhi banikeze ithebhu ye-Warfarin njengesinyathelo sokuvimbela ezigulini ezihlaselwe isifo senhliziyo. Kulezi zimo, imithi isiza ukunciphisa ingozi yokufa, ukuphindaphinda kwe-myocardial infarction, nezinye izenzakalo ze-thromboembolic ezingase zibe nzima ukululama.

Isetshenziswa kanjani i-Warfarin Tablet

Iziguli kufanele zithathe umthamo wazo onqunyiwe kanye ngosuku, okungcono kakhulu ntambama noma kusihlwa. Lesi sikhathi sivumela odokotela ukuthi balungise imithamo ngokusekelwe emiphumeleni yaselabhorethri yosuku olufanayo uma kudingeka.

Imihlahlandlela Yokuphatha Ebalulekile:

  • Thatha imithi ngesikhathi esifanayo usuku ngalunye
  • Landela umthamo onqunyiwe ngokuqondile
  • Ingathathwa ngokudla noma ngaphandle kokudla
  • Ungalokothi ulungise umthamo ngaphandle kokubonisana nodokotela
  • Gcina umbhalo walokho imithamo edayari yemithi

Imiphumela Emibi Yethebhulethi ye-Warfarin

Imiphumela engemihle ye-Warfarin ingasukela ekuphathekeni kabi kuya ezinkingeni ezingaba yingozi. 

Izinkinga zokopha zimelela ukukhathazeka okubaluleke kakhulu kubantu abathatha i-warfarin. Lokhu kungase kubonakale kanje:

  • Ukopha isikhathi eside ngenxa yokusikeka okuthatha imizuzu engaphezu kwe-10
  • Ukulimala noma ukuvuvukala okungajwayelekile
  • Igazi emcimbini (pink/nombala omnyama)
  • Igazi noma indle emnyama
  • Ukukhwehlela igazi
  • Ikhanda elibuhlungu noma isiyezi
  • Ukukhathala okungajwayelekile noma ubuthakathaka

Ezimweni ezingavamile, i-warfarin ingabangela umonakalo omkhulu wezicubu owaziwa nge-necrosis, ovame ukwenzeka phakathi nezinsuku ezimbalwa zokuqala zokwelashwa.

Izinkinga ezinzima okudinga usizo lwezokwelapha oluphuthumayo kuhlanganisa ukopha kwangaphakathi, okungase kuveze njengobuhlungu obukhulu besisu, ukudideka, ukukhuluma ngokukhathazeka, noma ubuthakathaka ohlangothini olulodwa lomzimba. 

Ukuqapha

Iziguli ezinezimo ezithile zezokwelapha zibhekana nezingozi ezengeziwe futhi zidinga ukuqapha okukhethekile ngesikhathi sokwelashwa.

  • I-Absolute Contraindications vimbela abantu abathile ukuthi bathathe i-warfarin, kuhlanganise nalabo abane:
    • Izinhlobonhlobo ezinkulu ze-esophageal
    • Ukuhlinzwa okukhulu kwakamuva (phakathi kwamahora angu-72)
    • Izimo eziphawulekayo zokopha
    • I-thrombocytopenia enzima
    • Isifo sesibindi esehlisiwe
  • Ukukhulelwa: abesifazane abakhulelwe zidinga ukucatshangelwa okukhethekile njengoba i-warfarin ingawela umgoqo we-placenta. Imithi ingase ibangele izinkinga zengane, okuhlanganisa ukukhipha isisu okuzenzakalelayo, ukubeletha, nokufa kwengane. 
  • Abantu Abadala: Iziguli esezikhulile zidinga ukubhekwa eduze ngenxa yokwanda kwezingozi zokopha ezihambisana nezici ezihlobene nobudala ezifana nokuwa, ukusebenzisana kwezidakamizwa, kanye nesimo sengqondo. Odokotela bavamise ukusebenzisa izindlela zokudosa ezilandelanayo zalaba bantu.
  • Ukuqapha: Ukuqapha kwe-INR okuvamile kuqinisekisa ukuphepha kokwelashwa, nemvamisa enqunywa izici zesiguli ngasinye. Iziguli kufanele zazise bonke odokotela ngokusetshenziswa kwazo i-Warfarin ngaphambi kwanoma yiziphi izinqubo zezokwelapha noma zamazinyo, njengoba kungase kudingeke ukuyeka okwesikhashana ukuze kuvinjwe izinkinga zokopha.

Isebenza kanjani i-Warfarin Tablet

Lo muthi ungumphikisi we-vitamin K, oqondise ngokusobala futhi ovimbela i-enzyme ebizwa ngokuthi i-vitamin K epoxide reductase.

Lapho i-warfarin ingena egazini, ivimbela ukugaywa kabusha kwe-vitamin K ngokuvimbela ukuguqulwa kwayo isuka ku-vitamin K epoxide iye kuvithamini K1. Lokhu kugxambukela kudala uchungechunge lwemiphumela ethinta indlela yomzimba yokujiyisa igazi. Umuthi ufinyelela lokhu ngokunciphisa ukukhiqizwa kwezinto ezimbalwa ezibalulekile zokuvala amahlule:

  • I-Factor VII (yehlisa izinga phakathi kwamahora angu-6)
  • Ama-Factors IX kanye no-X (amahora angu-24-36)
  • I-Thrombin (amahora angu-50)
  • Amaprotheni C no-S (amahora angu-8-24)

Ngingakwazi Ukuthatha I-Warfarin Ngeminye Imithi?

Imithi ejwayelekile okungathinta kakhulu ukusebenza kwe-warfarin kufaka phakathi:

  • Ama-antibiotics afana ne-ciprofloxacin ne-metronidazole
  • Imithi elwa namagciwane, ikakhulukazi i-fluconazole
  • aspirin
  • insangu
  • Imithi yesigqi senhliziyo njenge-amiodarone
  • Izidakamizwa ezingezona ukuvuvukala, njenge-ibuprofen noma i-celecoxib
  • Ukudambisa izinhlungu, kufaka phakathi i-acetaminophen ne-ibuprofen
  • Ama-salicylates
  • Imithi yokuquleka efana ne-phenytoin ne-carbamazepine

Ubuhlobo phakathi kwe-warfarin ne-aspirin budinga ukucatshangelwa okukhethekile. Nakuba ukwelashwa okuhlangene kungase kuzuzise iziguli ezinamavalvu enhliziyo yokufakelwa ezisengozini enkulu ye-thromboembolism, kwandisa izingozi zokopha. 

Ukuphuza kakhulu utshwala kuvimbela ukwakheka komuthi, kuyilapho ukuphuza okungapheli kungakhuphula izinga lokuwohloka kwawo, okungase kudinge ukulungiswa komthamo. 

Ulwazi Lomthamo

Umthamo onembile umele insika yokwelashwa okuphumelelayo kwe-Warfarin. Odokotela ngokuvamile baqala ukwelashwa ngo-2 kuya ku-5 mg othathwa kanye ngosuku, ukulungisa umthamo ngokusekelwe ekuqaphelweni okujwayelekile kwe-INR. Umthamo wesondlo uvamise ukuhluka phakathi kuka-2 kuya ku-10 mg nsuku zonke, nakuba izidingo zomuntu ngamunye zihluka kakhulu.

Izimo zezokwelapha ezihlukene zidinga ububanzi obuqondiwe be-INR:

Isimo Ibanga le-INR eliqondiwe
atrial Fibrillation 2.0 - 3.0
Deep Vein Thrombosis 2.0 - 3.0
Ama-Valve Enhliziyo Yemishini 2.5 - 3.5
I-Post-Myocardial Infarction 2.0 - 3.0

Isiphetho

I-Warfarin iwumuthi oyisisekelo ekwelashweni kwesimanje kwe-anticoagulation, efuna ukunakwa ngokucophelela ekudongeni, ekuqapheni, kanye nezindlela zokuphila ukuze kusebenze kahle. Impumelelo yesiguli ngalo muthi incike ekugcineni izinqubo zansuku zonke ezingashintshi, ukuhlolwa kwe-INR okuvamile, nokuxhumana okuseduze nodokotela. Ukusebenzelana okuyinkimbinkimbi phakathi kwe-warfarin nemithi ehlukahlukene, izithasiselo, nokukhetha kokudla kugcizelela isidingo semfundo yesiguli egcwele kanye nokwengamela kwezokwelapha okuqaphile.

Imibuzo Evame Ukubuzwa

1. Ingabe i-warfarin inemiphumela emibi? 

Umphumela ovame kakhulu we-warfarin ukopha. Kungasukela emihuzuko emincane kuye ukopha kakhulu ngaphakathi. Iziguli zingase zophe ngamakhala, ziphume ezinsinini, noma ziye esikhathini ezinzima kakhulu. Izinkinga ezingavamile zihlanganisa i-necrosis yesikhumba kanye nesifo sozwane olunsomi.

2. Kufanele ngiyithathe kanjani i-warfarin? 

Iziguli kufanele ziphuze i-warfarin kanye ngosuku ngesikhathi esifanayo, ngokuvamile kusihlwa. Ukuhlolwa kwe-INR okujwayelekile kuqondisa ukulungiswa komthamo. Ingathathwa uma umthamo weqiwe phakathi kwamahora ayisishiyagalombili; uma kungenjalo, linda umthamo ohleliwe olandelayo.

3. Ubani odinga i-warfarin? 

Iziguli ezine i-fibrillation ye-atrial, amavalvu enhliziyo ayimishini, amahlule egazi aphindelelayo, noma lawo asengozini enkulu ye-thromboembolism ngokuvamile adinga ukwelashwa kwe-Warfarin.

4. Zingaki izinsuku ongayithatha i-warfarin? 

Ubude besikhathi sokwelashwa buhluka ngokwemibandela. Ezinye iziguli zidinga ukwelashwa impilo yonke, kuyilapho ezinye zingakudinga izinyanga ezimbalwa. Odokotela banquma ubude besikhathi ngokusekelwe ezicini zengozi ngayinye.

5. Ingabe i-warfarin iphephile ukuthi uyiphuze nsuku zonke? 

Ukusetshenziswa kwansuku zonke kwe-Warfarin kuphephile uma kuqashwe ngokwanele ngokuhlolwa okujwayelekile kwe-INR nokulungiswa komthamo. Ukungaguquguquki kwesikhathi nomthamo kusiza ekugcineni amazinga okwelapha.

6. Ubani okungafanele athathe i-warfarin? 

Izinyathelo zokufakazela zihlanganisa:

  • Izifo zokopha kakhulu
  • Ukuhlinzwa okukhulu kwakamuva
  • ukukhulelwa (ngaphandle kwezimo ezithile)
  • ezinzima isifo sesibindi
  • Umlando wokuwa noma ingozi yokopha kakhulu

7. Ingabe i-warfarin inciphisa igazi?

Nakuba ngokuvamile ibizwa ngokuthi i-blood thinner, i-warfarin isebenza ngokuphazamisa i-vitamin K-ukukhiqizwa okuncikile kwe-clotting factor kunokunciphisa ukungaguquguquki kwegazi.

8. Uyini umehluko phakathi kwe-warfarin ne-heparin? 

I-Warfarin ithathwa ngomlomo ukuze isetshenziswe isikhathi eside, kuyilapho i-heparin idinga umjovo futhi ifanele ukwelashwa kwesikhashana. I-Warfarin ithatha izinsuku ezimbalwa ukuze ifinyelele umphumela ophelele, kuyilapho i-heparin isebenza ngokushesha.

9. Ingabe i-warfarin iphephile? 

Uma iqashwe kahle futhi ilawulwa, i-warfarin inikeza i-anticoagulation ephephile futhi ephumelelayo. Impumelelo incike ekuqaphelweni okuvamile, ukulinganisa okungaguquguquki, nokuthobela isiguli.

10. Yikuphi ukudla okufanele ukugweme lapho uthatha i-warfarin? 

Iziguli kufanele zilondoloze ukudla okungaguquki kokudla okunovithamini K kunokukugwema ngokuphelele. Nciphisa ukusetshenziswa kwe:

  • Ijusi ye-cranberry ne-grapefruit
  • Utshwala
  • Izinguquko ezisheshayo eziphawulekayo ekudleni kwemifino enamaqabunga aluhlaza