Osnove antikoagulacijskega zdravljenja. Maja Jošt, Erika Oblak
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1 Osnove antikoagulacijskega zdravljenja Maja Jošt, Erika Oblak Golnik, september 2011
2 Naša slikca
3 SMERNICE: KDO? KDAJ? ZAKAJ? KOLIKO ČASA? KATERO ZDRAVILO? Mavri A, Vene N. Smernice za vodenje antikoagulacijskega zdravljenja. Slovensko zdravniško društvo, Ljubljana, 2009 ESC Guidelines for the Management of With Atrial Fibrillation, European Heart Journal (2010) 31, ESC Guidelines on thr diagnosis and management of acute pulmonary embolism, European Heart Journal (2010) 31, American College of Chest Physicians: Evidence-Based Clinical Practice Guidelines: Antithrombotic and Trombolytic Therapy, 2008; 8. izdaja
4 KDO? KDAJ? ZAKAJ? Več kot bolnikov v Sloveniji Ob trombemboličnem zapletu oziroma tveganju zanj Porušena hemostaza
5 Triada po Virchowu
6 Arterijska in venska tromboza-razlike Arterijski strdek pretežno iz trombocitov, vsebujejo tudi fibrin in občasno levkocite na področjih hitrega pretoka- v arterijah embolusi lahko povzročijo srčni infarkt možgansko kap gangreno udov Venski strdek iz fibrina in eritrocitov v venah- odgovor na vensko stazo embolusi lahko povzročijo Globoko vensko trombozo Pljučne embolizme Postflebitični sindrom
7 KDO? KDAJ? ZAKAJ? KOLIKO ČASA? Več kot bolnikov v Sloveniji Ob trombemboličnem zapletu oziroma tveganju zanj Porušena hemostaza Dokler je prisoten dejavnik tveganja
8
9 KDO? KDAJ? ZAKAJ? KOLIKO ČASA? KATERO ZDRAVILO? Več kot bolnikov v Sloveniji Ob trombemboličnem zapletu oziroma tveganju zanj Porušena hemostaza Dokler je prisoten dejavnik tveganja Izbira zdravila glede na vrsto strdka Izbira zdravila glede na bolnika Izbira zdravila glede na patološke mehanizme
10 Zdravila za zdravljenje in preprečevanje trombemboličnih zapletov Antiagregacijska: Aspririn tiklopidin klopidogrel Antikoagulacijska: Varfarin Acenokumarol NMH Nefrakcionirani heparin Selektivni inhhibitor anti Xa Inhibitorji trombina Fibrinolitiki: Streptaza alteplaza
11 PE/ (G)VT Venski strdek nastane zaradi venske staze, če pride do nastanka embolusa, GVT lahko napreduje do PE AKUTNA FAZA: Nastanejo ogromne količine trombina in fibrina Inaktivacija trombina direktno: visoki odmerki heparina v bolusu, terapevtski odmerki NMH
12
13 PE/ (G)VT VZDRŽEVALNO ZDRAVLJENJE V ospredju je indirektna inaktivacija trombina preko faktorja Xa Varfarin / acenokumarol V nekaterih primerih terapevtski odmerki NMH Zakaj?
14 Preventiva kardiogenih tromboembolizmov 1. Atrijska fibrilacija (migetanje preddvorov) Nenormalna električna aktivnost v atrijih Nereden in hiter utrip srca Manjša iztisna učinkovitost atrija Staza krvi znotraj atrija, kar lahko vodi do nastanka atrijskih strdkov (avrikula levega atrija). Embolizacija nastalih strdkov v atriju najpogosteje vodi v možgansko kap antikoagulacijska zaščita z varfarinom tveganje za TE zmanjša za 70% aspirin v manjši meri (za 20%)
15 Atrijska fibrilacija (migetanje preddvorov) Delitev: Paroksizmalna (< 48h) Perzistentna Dolgotrajna perzistentna (> 1 leto) Permanentna NI pomembno za izbiro antitrombotika
16 1. Atrijska fibrilacija zdravljenje z AK je kompromis med varnostjo in učinkovitostjo VARNO UČINKOVITO Preprečitev neželenih dogodkov kot so majhne in velike krvavitve ali tromboembolični dogodki, ki so posledica AK terapije. Preprečitev nastanka tromboemboličnih dogodkov, ki so posledica osnovne bolezni. CHADS2 HAS BLED
17 1. Atrijska fibrilacija in sočasno prisotni dejavniki tveganja C= Cardiac failure H=Hypertension A=Age D=Diabetes S=Stroke VASc=Vascular disease CHA 2 DS 2 -VASc CHADS 2 Tveganje za možgansko kap (%/leto) Priporočena antitrombotična terapija 2 2 > 4 Antikoagulantna terapija 1 1 2,8 Antikoagulantna terapija ali aspirin mg/dan 0 0 1,9 Aspirin mg/dan ali brez antitrombotične terapije (ESC Guidelines for AF, 2010 )
18 Posebne populacije bolnikov Starejši: Večje tveganje za krvavitev Prilagajanje odmerkov NMH v primeru oslabljene ledvične funkcije Počasnejše uvajanje varfarina Nosečnice Varfarin je teratogen v prvem trimesečju Prehod na terapevtske odmerke NMH, spremljanje anti-xa aktivnosti
19 Posebne populacije bolnikov Prekomerna telesna teža: NMH se ne porazdeljujejo po maščobnem tkivu Ali odmerjanje na čisto telesno težo pomeni večje tveganje za krvavitev? Ledvična insuficienca: posebna previdnost pri odmerkih pri CrCl pod 30 ml/min Spremljanje anti-xa aktivnosti Prednost odmerjanja dvakrat dnevno?
20 ZAKLJUČEK Odločitev za uvedbo in izbiro AKZ temelji na oceni tveganja za trombemboličen zaplet in tveganja za neželene učinke Cilj k individualiziranemu zdravljenju (posebne populacije, komorbidnost, polipragmazija, )
21 VIRI IN LITERATURA Mavri A, Vene N. Smernice za vodenje antikoagulacijskega zdravljenja, 1.izdaja. Slovensko zdravniško društvo, Sekcija za antikoagulacijsko zdravljenje in preprečevanje tromboemboličnih bolezni pri Združenju za žilne bolezni, Ljubljana, Wittkowsy AK. Poglavje Thrombosis v Applied therapeutics, 8.izdaja. Lippincott Williams & Wilkins, Philadelphia, ESC Guidelines for the Management of With Atrial Fibrillation, European Heart Journal (2010) 31, ESC Guidelines on thr diagnosis and management of acute pulmonary embolism, European Heart Journal (2010) 31,
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