{"id":22537,"date":"2023-04-17T08:00:36","date_gmt":"2023-04-17T01:00:36","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22537"},"modified":"2023-04-17T10:54:58","modified_gmt":"2023-04-17T03:54:58","slug":"heparin-va-cac-van-de-thuong-gap-trong-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/heparin-va-cac-van-de-thuong-gap-trong-lam-sang\/","title":{"rendered":"Heparin v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong l\u00e2m s\u00e0ng"},"content":{"rendered":"

Heparin l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn trong l\u00e2m s\u00e0ng \u0111\u1ec3 ng\u0103n ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn \u0111\u00f4ng m\u00e1u, nh\u01b0 \u0111\u1ed9t qu\u1ef5 v\u00e0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u. Thu\u1ed1c n\u00e0y ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee7a fibrin, m\u1ed9t protein quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u. Heparin \u0111\u01b0\u1ee3c ti\u00eam tr\u1ef1c ti\u1ebfp v\u00e0o t\u0129nh m\u1ea1ch ho\u1eb7c d\u00f9ng d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c u\u1ed1ng v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nhi\u1ec1u t\u00ecnh hu\u1ed1ng kh\u00e1c nhau, t\u1eeb ph\u1eabu thu\u1eadt \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch.<\/strong><\/p>\n

1.Heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n<\/strong><\/h2>\n

1.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h3>\n
    \n
  • Heparin ti\u00eau chu\u1ea9n (hay c\u00f2n g\u1ecdi l\u00e0 heparin t\u1ef1 nhi\u00ean, heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n) l\u00e0 mucopolysaccharide t\u1ef1 nhi\u00ean c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed l\u1edbn (5.000 \u0111\u1ebfn 30.000 Dalton).<\/li>\n
  • C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: ch\u1ee7 y\u1ebfu t\u00e1c \u0111\u1ed9ng v\u00e0o con \u0111\u01b0\u1eddng \u0111\u00f4ng m\u00e1u n\u1ed9i sinh th\u00f4ng qua ph\u1ee9c h\u1ee3p heparin \u2013 antithrombin III \u2013 thrombin. Qua \u0111\u00f3, \u1ee9c ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thrombin, t\u0103ng s\u1ef1 ph\u00e2n hu\u1ef7 thrombin. Ngo\u00e0i ra, c\u00f2n b\u1ea5t ho\u1ea1t \u0111\u01b0\u1ee3c c\u1ea3 y\u1ebfu t\u1ed1 Xa v\u00e0 IXa.<\/li>\n<\/ul>\n

    1.2. Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h3>\n
      \n
    • \u0110i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u trong giai \u0111o\u1ea1n c\u1ea5p, bao g\u1ed3m thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/li>\n
    • Nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, t\u1eafc \u0111\u1ed9ng m\u1ea1ch ngo\u00e0i n\u00e3o v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/li>\n
    • D\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch v\u00e0\/ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch trong ph\u1eabu thu\u1eadt, \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n n\u1eb1m l\u00e2u ng\u00e0y sau b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh (sau nh\u1ed3i m\u00e1u c\u01a1 tim, suy tim, sau \u0111\u1ed9t qu\u1ef5 n\u00e3o k\u00e8m theo li\u1ec7t chi d\u01b0\u1edbi, b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng).<\/li>\n
    • D\u1ef1 ph\u00f2ng \u0111\u00f4ng m\u00e1u trong l\u1ecdc m\u00e1u ngo\u00e0i th\u1eadn ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u1ecdc m\u00e1u ngo\u00e0i c\u01a1 th\u1ec3.<\/li>\n
    • D\u1ef1 ph\u00f2ng \u0111\u00f4ng m\u00e1u trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p can thi\u1ec7p qua da b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch.<\/li>\n<\/ul>\n

      1.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eadn tr\u1ecdng<\/strong><\/h3>\n
        \n
      • Ti\u1ec1n s\u1eed gi\u1ea3m ti\u1ec3u c\u1ea7u n\u1eb7ng khi s\u1eed d\u1ee5ng heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n ho\u1eb7c heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p.<\/li>\n
      • B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd d\u1ec5 ch\u1ea3y m\u00e1u b\u1ea9m sinh. B\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u1edf c\u01a1 quan d\u1ec5 ch\u1ea3y m\u00e1u.<\/li>\n
      • B\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u ho\u1eb7c nguy c\u01a1 ch\u1ea3y m\u00e1u li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/li>\n
      • B\u1ec7nh nh\u00e2n ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd. T\u0103ng huy\u1ebft \u00e1p n\u1eb7ng kh\u00f3 ki\u1ec3m so\u00e1t.<\/li>\n<\/ul>\n

        1.4. C\u00e1ch t\u00ednh li\u1ec1u heparin truy\u1ec1n t\u0129nh m\u1ea1ch<\/strong><\/h3>\n

        1.4.1 Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi v\u00e0 thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/h4>\n
          \n
        • \u0110i\u1ec1u tr\u1ecb: Li\u1ec1u n\u1ea1p 80 UI\/kg (t\u1ed1i \u0111a 5000UI), sau \u0111\u00f3 truy\u1ec1n 18 UI\/kg\/h. Ch\u1ec9nh li\u1ec1u \u0111\u1ec3 aPTT (b\u1ec7nh\/ch\u1ee9ng) \u0111\u1ea1t m\u1ee5c ti\u00eau: 1,5 \u2013 2,3; aPTT: 46 \u2013 70 gi\u00e2y theo d\u00f5i 4 \u2013 6 h\/l\u1ea7n.<\/li>\n
        • D\u1ef1 ph\u00f2ng: 5000UI ti\u00eam d\u01b0\u1edbi da m\u1ed7i 8 \u2013 12h ho\u1eb7c 7500UI m\u1ed7i 12h.<\/li>\n<\/ul>\n

          1.4.2. Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean<\/h4>\n
            \n
          • B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh th\u00ec \u0111\u1ea7u: Li\u1ec1u n\u1ea1p 70-100 UI\/kg TM n\u1ebfu kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf GP IIb\/IIIa.<\/li>\n
          • Kh\u00f4ng \u0111\u01b0\u1ee3c can thi\u1ec7p t\u00e1i t\u01b0\u1edbi m\u00e1u: Li\u1ec1u n\u1ea1p 60 UI\/kg TM (li\u1ec1u t\u1ed1i \u0111a 4000UI) sau \u0111\u00f3 truy\u1ec1n t\u0129nh m\u1ea1ch v\u1edbi li\u1ec1u 12 UI\/kg (t\u1ed1i \u0111a 1000 UI\/h) cho 24-48h. M\u1ee5c ti\u00eau aPTT: 50-70s ho\u1eb7c 1,5-2 l\u1ea7n theo d\u00f5i t\u1ea1i th\u1eddi \u0111i\u1ec3m 3, 6, 12 v\u00e0 24h.<\/li>\n<\/ul>\n

            1.4.3. \u0110au ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh\/Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean<\/h4>\n

            Li\u1ec1u n\u1ea1p 60-70 UI\/kg TM (li\u1ec1u t\u1ed1i \u0111a 5000UI) sau \u0111\u00f3 truy\u1ec1n t\u0129nh m\u1ea1ch v\u1edbi li\u1ec1u 12-15 UI\/kg\/h (li\u1ec1u t\u1ed1i \u0111a 100 UI\/h). M\u1ee5c ti\u00eau aPTT: 50 \u2013 70s.<\/p>\n

            1.4.4. C\u00e1ch \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u<\/h4>\n\n\n\n\n\n\n\n\n
            aPTT (b\u1ec7nh\/ch\u1ee9ng)<\/td>\nThay \u0111\u1ed5i li\u1ec1u<\/td>\n<\/tr>\n
            < 1,2<\/td>\nLi\u1ec1u n\u1ea1p 80 UI\/kg, sau \u0111\u00f3 t\u0103ng 4 UI\/kg\/h<\/td>\n<\/tr>\n
            1,2 \u2013 1,5<\/td>\nLi\u1ec1u n\u1ea1p 40 UI\/kg, sau \u0111\u00f3 t\u0103ng 2 UI\/kg\/h<\/td>\n<\/tr>\n
            1,5 \u2013 2,3<\/td>\nKh\u00f4ng thay \u0111\u1ed5i<\/td>\n<\/tr>\n
            2,3 \u2013 3,0<\/td>\nGi\u1ea3m t\u1ed1c \u0111\u1ed9 truy\u1ec1n 2 UI\/kg\/h<\/td>\n<\/tr>\n
            > 3,0<\/td>\nD\u1eebng truy\u1ec1n 1h, sau \u0111\u00f3 gi\u1ea3m 3 UI\/kg\/h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

            1.5. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/h3>\n
              \n
            • Ch\u1ea3y m\u00e1u, t\u1ee5 m\u00e1u.<\/li>\n
            • Gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin (HIT). Lo\u00e3ng x\u01b0\u01a1ng.<\/li>\n<\/ul>\n

              2.Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p<\/strong><\/h2>\n

              2.1. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h3>\n

              Trong khi heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n t\u00e1c d\u1ee5ng tr\u00ean y\u1ebfu t\u1ed1 IIa v\u00e0 Xa th\u00ec heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (TLPTT) t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu th\u00f4ng qua c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xa. \u0110i\u1ec3m \u0111\u00e1ng ch\u00fa \u00fd c\u1ee7a heparin TLPTT l\u00e0 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i n\u00ean ch\u1ec9 c\u1ea7n ti\u00eam 1 \u2013 2 l\u1ea7n\/24h.<\/p>\n

              T\u1ea5t c\u1ea3 c\u00e1c heparin TLPTT \u0111\u1ec1u c\u00f3 m\u1ed9t v\u00f9ng pentasaccharide \u0111\u1eb7c hi\u1ec7u. Nh\u1edd c\u00f3 v\u00f9ng pentasaccharide n\u00e0y, heparin TLPTT c\u00f3 th\u1ec3 g\u1eafn v\u1edbi antithrombin III v\u00e0 gia t\u0103ng t\u1ed1c \u0111\u1ed9 ph\u1ea3n \u1ee9ng. Qu\u00e1 tr\u00ecnh \u1ee9c ch\u1ebf thrombin (y\u1ebfu t\u1ed1 IIa) c\u1ea7n s\u1ef1 li\u00ean k\u1ebft \u0111\u1ed3ng th\u1eddi c\u1ee7a chu\u1ed7i heparin v\u1edbi antithrombin III v\u00e0 thrombin, trong khi \u0111\u00f3 qu\u00e1 tr\u00ecnh \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xa ch\u1ec9 c\u1ea7n li\u00ean k\u1ebft gi\u1eefa chu\u1ed7i heparin v\u00e0 antithrombin III. V\u00ec v\u1eady, nh\u1eefng chu\u1ed7i kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed d\u01b0\u1edbi 5400 Dalton ch\u1ec9 c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng Xa, trong khi nh\u1eefng chu\u1ed7i c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed l\u1edbn h\u01a1n 5400 Dalton c\u00f3 c\u1ea3 t\u00e1c d\u1ee5ng kh\u00e1ng IIa. C\u00e1c heparin TLPTT c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng ph\u00e2n t\u1eed nh\u1ecf n\u00ean c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng Xa m\u1ea1nh h\u01a1n t\u00e1c d\u1ee5ng kh\u00e1ng IIa.<\/p>\n

              2.2. Ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u d\u00f9ng<\/strong><\/h3>\n

              C\u00e1c ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u d\u00f9ng c\u1ee7a enoxaparin<\/p>\n\n\n\n\n\n\n\n\n
              Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/td>\n\n

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

              D\u1ef1 ph\u00f2ng b\u1ec7nh thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch.<\/td>\n4000UI (40 mg) ti\u00eam d\u01b0\u1edbi da m\u1ed9t l\u1ea7n\/24h.<\/td>\n<\/tr>\n
              \u0110i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u v\u00e0 thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PE).<\/td>\n100 UI\/kg (1 mg\/kg) ti\u00eam d\u01b0\u1edbi da m\u1ed7i 12h ho\u1eb7c 1,5mg\/kg m\u1ed9t l\u1ea7n\/24h<\/td>\n<\/tr>\n
              \u0110i\u1ec1u tr\u1ecb \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean (NSTEMI).<\/td>\n100UI\/kg (1 mg\/kg) m\u1ed7i 12h ti\u00eam d\u01b0\u1edbi da.<\/td>\n<\/tr>\n
              \u0110i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean (STEMI) (b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 75 tu\u1ed5i).<\/td>\nLi\u1ec1u n\u1ea1p ti\u00eam t\u0129nh m\u1ea1ch (t\u0129nh m\u1ea1ch bolus) 3000UI (30 mg) c\u1ed9ng v\u1edbi li\u1ec1u 100 UI\/kg (1 mg\/kg) ti\u00eam d\u01b0\u1edbi da (SC) v\u00e0 ti\u1ebfp theo sau l\u00e0 li\u1ec1u 100 UI\/kg (1 mg\/kg) ti\u00eam d\u01b0\u1edbi da m\u1ed7i 12h (t\u1ed1i \u0111a 10000UI (100 mg) cho hai li\u1ec1u ti\u00eam d\u01b0\u1edbi da \u0111\u1ea7u ti\u00ean).<\/td>\n<\/tr>\n
              \u0110i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean (STEMI) (b\u1ec7nh nh\u00e2n tr\u00ean 75 tu\u1ed5i).<\/td>\nKh\u00f4ng c\u00f3 ti\u00eam li\u1ec1u n\u1ea1p t\u0129nh m\u1ea1ch (TM bolus) ban \u0111\u1ea7u, b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u 75 UI\/kg (0,75 mg\/kg) ti\u00eam d\u01b0\u1edbi da m\u1ed7i 12h (t\u1ed1i \u0111a 7500UI (75 mg) cho hai li\u1ec1u ti\u00eam d\u01b0\u1edbi da \u0111\u1ea7u ti\u00ean, ti\u1ebfp theo l\u00e0 li\u1ec1u 75 UI\/kg (0,75 mg\/kg) ti\u00eam d\u01b0\u1edbi da cho c\u00e1c li\u1ec1u duy tr\u00ec).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

               <\/p>\n\n\n\n\n
              B\u1ec7nh nh\u00e2n suy th\u1eadn v\u1edbi MLCT t\u1eeb 15 \u0111\u1ebfn 30 mL\/ph\u00fat.<\/td>\nGi\u1ea3m li\u1ec1u c\u00f2n 1 mg\/kg\/24h (ti\u00eam d\u01b0\u1edbi da ng\u00e0y 1 l\u1ea7n).<\/td>\n<\/tr>\n
              B\u1ec7nh nh\u00e2n suy th\u1eadn c\u00f3 MLCT < 15 mL\/ph\u00fat ho\u1eb7c \u0111ang l\u1ecdc m\u00e1u chu k\u1ef3.<\/td>\nN\u00ean chuy\u1ec3n sang heparin KP\u0110.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

              2.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h3>\n
                \n
              • Ti\u1ec1n s\u1eed gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin TLPTT ho\u1eb7c heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n.<\/li>\n
              • Hi\u1ec7n \u0111ang ch\u1ea3y m\u00e1u ho\u1eb7c c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u do r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/li>\n
              • T\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u01a1 quan d\u1ec5 ch\u1ea3y m\u00e1u. Ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd.<\/li>\n<\/ul>\n

                2.4. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/h3>\n
                  \n
                • Ch\u1ea3y m\u00e1u.<\/li>\n
                • T\u1ee5 m\u00e1u t\u1ea1i v\u1ecb tr\u00ed ti\u00eam.<\/li>\n
                • Gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin (HIT).<\/li>\n
                • Nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng khi s\u1eed d\u1ee5ng d\u00e0i ng\u00e0y.<\/li>\n
                • Ngo\u00e0i ra c\u00f3 th\u1ec3 g\u1eb7p m\u1ed9t s\u1ed1 ch\u1ebf ph\u1ea9m kh\u00e1c c\u1ee7a heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n tr\u00ean th\u1ecb tr\u01b0\u1eddng nh\u01b0 dalteparin\u2026<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                  Heparin l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn trong l\u00e2m s\u00e0ng \u0111\u1ec3 ng\u0103n ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn \u0111\u00f4ng m\u00e1u, nh\u01b0 \u0111\u1ed9t qu\u1ef5 v\u00e0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u. Thu\u1ed1c n\u00e0y ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee7a fibrin, m\u1ed9t protein quan tr\u1ecdng trong […]<\/p>\n","protected":false},"author":7,"featured_media":22541,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nHeparin v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Heparin v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p trong l\u00e2m s\u00e0ng l\u00e0 \u0111i\u1ec1u \u0111\u01b0\u1ee3c quan t\u00e2m. 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