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相关概念视频

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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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解决肝素耐药性的故障

Cheryl L Maier1, Jean M Connors2, Jerrold H Levy3

  • 1Department of Pathology and Laboratory Medicine, Emory School of Medicine, Atlanta, GA.

Hematology. American Society of Hematology. Education Program
|December 7, 2024
PubMed
概括
此摘要是机器生成的。

当未分离的 (UFH) 无法达到治疗性抗凝作用时,发生氨酸耐药性. 原因包括高凝血和错误的剂量,需要替代治疗或监测方法.

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科学领域:

  • 药理学 药理学是指药理学的学科.
  • 血液学 血液学 血液学
  • 临床医学 临床医学

背景情况:

  • 氨酸耐药性被定义为未分离氨酸 (UFH) 无法达到治疗性抗凝血水平,尽管适当的剂量.
  • 目前的监测测定,如激活的部分血栓形成时间 (APTT) 和激活的凝血时间 (ACT),容易受到炎症和感染等因素的干扰,特别是在COVID-19大流行等事件期间.
  • 这导致许多机构采用抗Xa测试,以更可靠地监测肝素.

研究的目的:

  • 为了澄清肝素耐药性的定义和原因.
  • 讨论传统的肝素监测试验的局限性.
  • 概述目前和替代性治疗策略,治疗肝素耐药性.

主要方法:

  • 审查关于抗肝素耐药性,抗凝血监测和治疗方案的现有文献.
  • 分析影响肝素疗效的因素和监测试验可靠性的分析.
  • 综合有关肝素耐药性原因,诊断和管理的信息.

主要成果:

  • 对于"适当的剂量"或"预先确定的水平"的抗凝剂来定义氨酸耐药性,没有确立的共识.
  • 传统的基于凝块的测试 (aPTT,ACT) 在某些临床条件下不可靠,促使人们转向抗Xa测试.
  • 氨酸耐药性的确定的原因包括高凝血性,抗血缺乏,血栓塞动症,抗脂抗体综合征和使用andexanet alfa.
  • 治疗方案包括调整UFH剂量,抗血补充剂或替代抗凝剂,如直接血抑制剂.

结论:

  • 由于未定义的参数和不可靠的监测方法,氨酸耐药性存在重大临床挑战.
  • 了解肝素耐药性的多因素原因对于有效的患者管理至关重要.
  • 替代性抗凝剂和先进的监测技术为表现出肝素耐药性的患者提供了可行的解决方案.