{"id":22506,"date":"2023-04-18T11:31:40","date_gmt":"2023-04-18T04:31:40","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22506"},"modified":"2023-04-18T12:29:21","modified_gmt":"2023-04-18T05:29:21","slug":"clopidogrel-va-cac-van-de-trong-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/clopidogrel-va-cac-van-de-trong-dieu-tri\/","title":{"rendered":"Clopidogrel v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 trong \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Clopidogrel l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc vi\u1ec7c g\u1eafn c\u1ee7a adenosine diphosphate (ADP) l\u00ean th\u1ee5 th\u1ec3 c\u1ee7a n\u00f3 \u1edf ti\u1ec3u c\u1ea7u d\u1eabn \u0111\u1ebfn s\u1ef1 ho\u1ea1t h\u00f3a qua trung gian ADP c\u1ee7a ph\u1ee9c h\u1ee3p glycoprotein GPIIb\/IIIa, do v\u1eady m\u00e0 \u1ee9c ch\u1ebf s\u1ef1 ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u. Ngo\u00e0i ra clopidogrel c\u00f2n t\u00e1c \u0111\u1ed9ng b\u1eb1ng s\u1ef1 bi\u1ebfn \u0111\u1ed5i kh\u00f4ng h\u1ed3i ph\u1ee5c th\u1ee5 th\u1ec3 ADP ti\u1ec3u c\u1ea7u.<\/strong><\/p>\n

1.\u0110\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c l\u00fd.<\/h2>\n

Clopidogrel l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc vi\u1ec7c g\u1eafn c\u1ee7a adenosine diphosphate (ADP) l\u00ean th\u1ee5 th\u1ec3 c\u1ee7a n\u00f3 \u1edf ti\u1ec3u c\u1ea7u d\u1eabn \u0111\u1ebfn s\u1ef1 ho\u1ea1t h\u00f3a qua trung gian ADP c\u1ee7a ph\u1ee9c h\u1ee3p glycoprotein GPIIb\/IIIa, do v\u1eady m\u00e0 \u1ee9c ch\u1ebf s\u1ef1 ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u. Ngo\u00e0i ra clopidogrel c\u00f2n t\u00e1c \u0111\u1ed9ng b\u1eb1ng s\u1ef1 bi\u1ebfn \u0111\u1ed5i kh\u00f4ng h\u1ed3i ph\u1ee5c th\u1ee5 th\u1ec3 ADP ti\u1ec3u c\u1ea7u. C\u00e1c ti\u1ec3u c\u1ea7u g\u1eafn k\u1ebft v\u1edbi thu\u1ed1c s\u1ebd b\u1ecb \u1ee9c ch\u1ebf trong su\u1ed1t \u0111\u1eddi s\u1ed1ng c\u00f2n l\u1ea1i c\u1ee7a ti\u1ec3u c\u1ea7u v\u00e0 t\u1ed1c \u0111\u1ed9 h\u1ed3i ph\u1ee5c ch\u1ee9c n\u0103ng c\u1ee7a ti\u1ec3u c\u1ea7u v\u1ec1 b\u00ecnh th\u01b0\u1eddng x\u1ea3y ra tr\u00f9ng v\u1edbi t\u1ed1c \u0111\u1ed9 s\u1ea3n sinh ti\u1ec3u c\u1ea7u.<\/p>\n

Clopidogrel \u1ee9c ch\u1ebf s\u1ef1 k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u d\u1eabn \u0111\u1ebfn gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng, nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5. Clopidogrel \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh ch\u00f3ng sau khi u\u1ed1ng. H\u1ea5p thu t\u1ed1i thi\u1ec3u 50%. Clopidogrel l\u00e0 m\u1ed9t ti\u1ec1n ch\u1ea5t, chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu t\u1ea1i gan, v\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu d\u1ea1ng kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng l\u00e0 d\u1eabn xu\u1ea5t acid carboxylic. Ph\u1ea7n c\u00f3 ho\u1ea1t t\u00ednh \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a qua cytochrom P450, isoenzym CYP3A4 v\u00e0 CYP2B6, CYP1A2, CYP1A1, CYP2C19. T\u00e1c \u0111\u1ed9ng kh\u00e1ng ti\u1ec3u c\u1ea7u v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a thu\u1ed1c thay \u0111\u1ed5i t\u00f9y theo ki\u1ec3u gen CYP2C19.<\/p>\n

Clopidogrel v\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a ch\u00ednh c\u1ee7a n\u00f3 g\u1eafn k\u1ebft cao v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng. Clopidogrel v\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a n\u00f3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft qua n\u01b0\u1edbc ti\u1ec3u (kho\u1ea3ng 50%) v\u00e0 qua ph\u00e2n (46%)<\/p>\n

2.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a clopidogrel.<\/h2>\n

Ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc s\u1ef1 g\u1eafn ADP v\u1edbi th\u1ee5 th\u1ec3 P2Y12. C\u00e1c th\u1ee5 th\u1ec3 P2Y12 k\u1ebft h\u1ee3p v\u1edbi protetin G \u1ee9c ch\u1ebf (Gi). Sau \u0111\u01b0\u1ee3c k\u00edch th\u00edch b\u1edfi ADP, th\u1ee5 th\u1ec3 P2Y12 \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a v\u00e0 \u1ee9c ch\u1ebf adenylatecylase (AC) d\u1eabn t\u1edbi l\u00e0m gi\u1ea3m ho\u1ea1t t\u00ednh c\u1ee7a protein kinase ph\u1ee5 thu\u1ed9c cAMP, do \u0111\u00f3 l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh phosphoryl h\u00f3a c\u1ee7a phosphoprotein k\u00edch th\u00edch gi\u00e3n m\u1ea1ch (VASP). PGE1 k\u00edch th\u00edch th\u1ee5 th\u1ec3 k\u1ebft h\u1ee3p Gs v\u00e0 ho\u1ea1t h\u00f3a AC, l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh c\u1ee7a protein kinase ph\u1ee5 thu\u1ed9c cAMP v\u00e0 l\u00e0m t\u0103ng phosphoryl h\u00f3a VASP. VASP sau khi phosphoryl h\u00f3a c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf ho\u1ea1t h\u00f3a th\u1ee5 th\u1ec3 GP IIb\/IIIa.<\/p>\n

3.Ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u l\u01b0\u1ee3ng clopidogrel<\/h2>\n\n\n\n\n\n\n\n
\n

Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n<\/td>\n

\n

Li\u1ec1u d\u00f9ng<\/strong><\/p>\n<\/td>\n<\/tr>\n

D\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n sau nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean.<\/td>\nClopidogrel \u0111\u01a1n tr\u1ecb li\u1ec7u: 75 mg\/24h.<\/td>\n<\/tr>\n
Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00ean (STEMI).<\/td>\nS\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi aspirin, li\u1ec1u n\u1ea1p 600 mg, sau \u0111\u00f3 duy tr\u00ec 75 mg\/24h.<\/td>\n<\/tr>\n
Nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng ST ch\u00eanh l\u00ean (NSTEMI).<\/td>\nS\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi aspirin, li\u1ec1u n\u1ea1p 300-600 mg, sau \u0111\u00f3 duy tr\u00ec 75 mg\/24h.<\/td>\n<\/tr>\n
Sau can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da.<\/td>\nDuy tr\u00ec 75 mg\/24h.Th\u1eddi gian d\u00f9ng ph\u1ee5 thu\u1ed9c nguy c\u01a1 xu\u1ea5t huy\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c d\u00f9ng ph\u1ed1i h\u1ee3p (thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

4.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eadn tr\u1ecdng<\/h2>\n
    \n
  • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: m\u1eabn c\u1ea3m v\u1edbi clopidogrel ho\u1eb7c d\u1ecb \u1ee9ng v\u1edbi b\u1ea5t k\u1ef3 th\u00e0nh ph\u1ea7n n\u00e0o c\u1ee7a thu\u1ed1c, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan n\u1eb7ng, xu\u1ea5t huy\u1ebft \u0111ang ti\u1ebfn tri\u1ec3n, ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa.<\/li>\n
  • Th\u1eadn tr\u1ecdng: b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao xu\u1ea5t huy\u1ebft( c\u00f3 ti\u1ec1n s\u1eed ch\u1ea3y m\u00e1u d\u01b0\u1edbi da ho\u1eb7c c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 m\u00e1u), \u0111\u1ed9t qu\u1ef5 n\u00e3o m\u1edbi, suy th\u1eadn.<\/li>\n<\/ul>\n

    5.T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/h2>\n
      \n
    • Ban \u0111\u1ecf ngo\u00e0i da l\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n th\u01b0\u1eddng g\u1eb7p khi s\u1eed d\u1ee5ng clopidogrel. C\u1ea7n theo d\u00f5i s\u00e1t v\u00e0 ph\u00e2n bi\u1ec7t \u0111\u1ecf da do tia X \u1edf c\u00e1c b\u1ec7nh nh\u00e2n sau khi can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da (trong v\u00f2ng 1 tu\u1ea7n \u0111\u1ea7u ti\u00ean) v\u1edbi \u0111\u1ecf da do m\u1eabn c\u1ea3m v\u1edbi clopidogrel \u0111\u1ec3 tr\u00e1nh vi\u1ec7c d\u1eebng \u0111i\u1ec1u tr\u1ecb clopidogrel. N\u1ebfu \u0111\u1ecf da m\u1ee9c \u0111\u1ed9 nh\u1eb9 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng histamin, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc thay th\u1ebf clopidogrel b\u1eb1ng prasugrel ho\u1eb7c ticagrelor.<\/li>\n
    • T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n l\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a kh\u00e1 th\u01b0\u1eddng g\u1eb7p, bao g\u1ed3m c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 ti\u00eau ch\u1ea3y, \u0111au b\u1ee5ng, r\u1ed1i lo\u1ea1n b\u00e0i ti\u1ebft d\u1ecbch v\u1ecb.<\/li>\n
    • Xu\u1ea5t huy\u1ebft l\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p, v\u00ed d\u1ee5 nh\u01b0 xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y, ru\u1ed9t, v\u1ebft b\u1ea7m t\u00edm ho\u1eb7c xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da, \u0111\u1eb7c bi\u1ec7t khi d\u00f9ng ph\u1ed1i h\u1ee3p gi\u1eefa aspirin v\u00e0 clopidogrel. M\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n g\u1eb7p c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 m\u00e1u nh\u01b0 gi\u1ea3m ti\u1ec3u c\u1ea7u hay gi\u1ea3m b\u1ea1ch c\u1ea7u.<\/li>\n<\/ul>\n

      6.T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/h2>\n

      PPI (Proton Pump Inhibitor) v\u00e0 Clopidogrel l\u00e0 hai lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 t\u00ecnh tr\u1ea1ng tim m\u1ea1ch. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng c\u00f9ng l\u00fac PPI v\u00e0 Clopidogrel c\u00f3 th\u1ec3 g\u00e2y ra t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

      Vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi m\u1ed9t s\u1ed1 thu\u1ed1c PPIs nh\u01b0 omeprazole, esomeprazole\u2026c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng t\u1edbi hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a clopidogrel. C\u1ee5 th\u1ec3, PPI l\u00e0m gi\u1ea3m ho\u1ea1t t\u00ednh c\u1ee7a enzyme CYP2C19, l\u00e0 m\u1ed9t trong nh\u1eefng enzyme c\u1ea7n thi\u1ebft \u0111\u1ec3 chuy\u1ec3n \u0111\u1ed5i clopidogrel th\u00e0nh d\u1ea1ng ho\u1ea1t \u0111\u1ed9ng. Khi s\u1eed d\u1ee5ng PPI, ho\u1ea1t t\u00ednh c\u1ee7a enzyme CYP2C19 gi\u1ea3m, l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng chuy\u1ec3n \u0111\u1ed5i clopidogrel th\u00e0nh d\u1ea1ng ho\u1ea1t \u0111\u1ed9ng v\u00e0 l\u00e0m t\u0103ng nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/p>\n

      7.K\u1ebft lu\u1eadn<\/h2>\n

      Clopidogrel l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng trong m\u1ea1ch m\u00e1u v\u00e0 ng\u0103n ng\u1eeba c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed9t qu\u1ef5 v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim. Thu\u1ed1c n\u00e0y ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf s\u1ef1 li\u00ean k\u1ebft gi\u1eefa c\u00e1c ti\u1ec3u c\u1ea7u trong m\u00e1u, l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng trong m\u1ea1ch m\u00e1u. Clopidogrel \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n sau khi \u0111\u00e3 tr\u1ea3i qua m\u1ed9t s\u1ed1 lo\u1ea1i ph\u1eabu thu\u1eadt tim m\u1ea1ch ho\u1eb7c \u0111\u1ed9t qu\u1ef5<\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      Clopidogrel l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc vi\u1ec7c g\u1eafn c\u1ee7a adenosine diphosphate (ADP) l\u00ean th\u1ee5 th\u1ec3 c\u1ee7a n\u00f3 \u1edf ti\u1ec3u c\u1ea7u d\u1eabn \u0111\u1ebfn s\u1ef1 ho\u1ea1t h\u00f3a qua trung gian ADP c\u1ee7a ph\u1ee9c h\u1ee3p glycoprotein GPIIb\/IIIa, do v\u1eady m\u00e0 \u1ee9c ch\u1ebf s\u1ef1 ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u. Ngo\u00e0i ra clopidogrel c\u00f2n t\u00e1c \u0111\u1ed9ng b\u1eb1ng s\u1ef1 bi\u1ebfn […]<\/p>\n","protected":false},"author":7,"featured_media":22508,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nClopidogrel v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 trong \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Clopidogrel l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c th\u01b0\u1eddng d\u00f9ng trong b\u1ec7nh tim m\u1ea1ch. Trong b\u00e0i vi\u1ebft d\u01b0\u1edbi d\u00e2y s\u1ebd cung c\u1ea5p th\u00eam c\u00e1c th\u00f4ng tin.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Clopidogrel v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 trong \u0111i\u1ec1u tr\u1ecb - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Clopidogrel l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c th\u01b0\u1eddng d\u00f9ng trong b\u1ec7nh tim m\u1ea1ch. 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