{"id":22561,"date":"2023-04-17T07:58:48","date_gmt":"2023-04-17T00:58:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22561"},"modified":"2023-04-17T10:56:20","modified_gmt":"2023-04-17T03:56:20","slug":"noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/","title":{"rendered":"NOAC (New Oral Anticoagulants) &#8211; thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t?"},"content":{"rendered":"<p><strong>NOAC (New Oral Anticoagulants) l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u1edbi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn \u0111\u00f4ng m\u00e1u, nh\u01b0ng kh\u00e1c v\u1edbi heparin, ch\u00fang \u0111\u01b0\u1ee3c d\u00f9ng d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c u\u1ed1ng. C\u00e1c lo\u1ea1i NOAC g\u1ed3m: Rivaroxaban,Dabigatran&#8230;<\/strong><\/p>\n<h2><strong>1.Rivaroxaban<\/strong><\/h2>\n<p>Rivaroxaban l\u00e0 m\u1ed9t NOAC \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xa. Thu\u1ed1c n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh vai tr\u00f2 hi\u1ec7u qu\u1ea3 trong d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 kh\u00f4ng do b\u1ec7nh van tim qua nhi\u1ec1u nghi\u00ean c\u1ee9u.<\/p>\n<h3>1.1. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n<ul>\n<li>Rivaroxaban\u00a0 l\u00e0 NOAC d\u1ea1ng kh\u00f4ng b\u1ecb chuy\u1ec3n h\u00f3a l\u00e0 h\u1ee3p ch\u1ea5t quan tr\u1ecdng nh\u1ea5t trong huy\u1ebft t\u01b0\u01a1ng ng\u01b0\u1eddi. Rivaroxaban l\u00e0 nh\u00f3m thu\u1ed1c c\u00f3 s\u1ef1 thanh th\u1ea3i ch\u1eadm v\u1edbi \u0111\u1ed9 thanh th\u1ea3i kho\u1ea3ng 10 L\/h. S\u1ef1 th\u1ea3i tr\u1eeb c\u1ee7a rivaroxaban kh\u1ecfi huy\u1ebft t\u01b0\u01a1ng x\u1ea3y ra v\u1edbi th\u1eddi gian b\u00e1n h\u1ee7y t\u1eeb 5-9h \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i v\u00e0 t\u1eeb 11-13h \u1edf ng\u01b0\u1eddi cao tu\u1ed5i.<\/li>\n<li>H\u1ea5p thu c\u1ee7a rivaroxaban g\u1ea7n nh\u01b0 to\u00e0n b\u1ed9: V\u1edbi vi\u00ean 2,5-10 mg, sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng t\u1eeb 80-100%, b\u1ea5t k\u1ec3 nh\u1ecbn \u0111\u00f3i ho\u1eb7c sau \u0103n. Vi\u00ean 20 mg, sinh kh\u1ea3 d\u1ee5ng l\u00fac \u0111\u00f3i \u0111\u1ea1t kho\u1ea3ng 66%; khi d\u00f9ng c\u00f9ng th\u1ee9c \u0103n, thu\u1ed1c h\u1ea5p thu g\u1ea7n nh\u01b0 ho\u00e0n to\u00e0n.<\/li>\n<\/ul>\n<h3>1.2. Ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u d\u00f9ng<\/h3>\n<ul>\n<li>Rung nh\u0129 kh\u00f4ng do b\u1ec7nh van tim: Theo nghi\u00ean c\u1ee9u ROCKET-AF, rivaroxaban 20 mg x 1 l\u1ea7n\/24h cho th\u1ea5y hi\u1ec7u qu\u1ea3 h\u01a1n warfarin trong d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5, t\u1eafc m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 kh\u00f4ng do b\u1ec7nh van tim v\u00e0 nguy c\u01a1 ch\u1ea3y m\u00e1u nh\u01b0 nhau. C\u00e1c nghi\u00ean c\u1ee9u pha III v\u00e0 th\u1ebf gi\u1edbi th\u1ef1c cho th\u1ea5y rivaroxaban c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n h\u01a1n so v\u1edbi warfarin tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n nguy c\u01a1 cao nh\u01b0 cao tu\u1ed5i, suy th\u1eadn, ti\u1ec1n s\u1eed \u0111\u1ed9t qu\u1ef5 n\u00e3o, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Kh\u00f4ng c\u1ea7n ch\u1ec9nh li\u1ec1u rivaroxaban d\u1ef1a theo tu\u1ed5i, c\u00e2n n\u1eb7ng ho\u1eb7c ch\u1ee7ng t\u1ed9c. Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 15 \u2013 50 mL\/ph\u00fat, d\u00f9ng li\u1ec1u 15mg, 1l\u1ea7n\/24h. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, rivaroxaban v\u1eabn cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u00e0 an to\u00e0n \u01b0u th\u1ebf h\u01a1n warfarin.<\/li>\n<li>\u00a0Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi: Khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng rivaroxaban th\u00ec kh\u00f4ng c\u1ea7n kh\u1edfi \u0111\u1ea7u v\u1edbi ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam. C\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y, so v\u1edbi li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u1edbi enoxaparin trong 5 ng\u00e0y b\u1eafc c\u1ea7u v\u1edbi kh\u00e1ng vitamin K, rivaroxaban c\u00f3 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u00e0 nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u1eb7ng l\u00e0 th\u1ea5p h\u01a1n.<\/li>\n<li>Li\u1ec1u d\u00f9ng: 15 mg x 2 l\u1ea7n\/24h trong v\u00f2ng 21 ng\u00e0y \u0111\u1ea7u ti\u00ean, sau \u0111\u00f3 ti\u1ebfp t\u1ee5c v\u1edbi li\u1ec1u 20 mg x 1 l\u1ea7n\/24h.<\/li>\n<\/ul>\n<p>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u00f9y theo c\u0103n nguy\u00ean, nguy c\u01a1 huy\u1ebft kh\u1ed1i c\u0169ng nh\u01b0 nguy c\u01a1 xu\u1ea5t huy\u1ebft c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n. Khuy\u1ebfn c\u00e1o t\u1ed1i thi\u1ec3u d\u00f9ng NOAC l\u00e0 3 th\u00e1ng.<\/p>\n<ul>\n<li>Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: Li\u1ec1u d\u00f9ng v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb rivaroxaban trong \u0111i\u1ec1u tr\u1ecb thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u01b0\u01a1ng t\u1ef1 trong \u0111i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi.<\/li>\n<\/ul>\n<p>Khuy\u1ebfn c\u00e1o m\u1edbi nh\u1ea5t n\u0103m 2019 c\u1ee7a H\u1ed9i tim m\u1ea1ch h\u1ecdc ch\u00e2u \u00c2u v\u1ec1 qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p:<\/p>\n<ul>\n<li>Khi s\u1eed d\u1ee5ng kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, NOAC, trong \u0111\u00f3 c\u00f3 rivaroxaban \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o h\u01a1n l\u00e0 VKA (I).<\/li>\n<li>Tr\u00ean b\u1ec7nh nh\u00e2n ung th\u01b0 b\u1ecb thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, rivaroxaban l\u00e0 thu\u1ed1c NOAC \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o c\u00f3 th\u1ec3 thay th\u1ebf cho heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (LMWH), ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (IIa).<\/li>\n<li>D\u1ef1 ph\u00f2ng bi\u1ebfn ch\u1ee9ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi (HKTM) sau ph\u1eabu thu\u1eadt thay th\u1ebf kh\u1edbp g\u1ed1i, kh\u1edbp h\u00e1ng: Nghi\u00ean c\u1ee9u RECORD v\u1ec1 ph\u00f2ng ng\u1eeba bi\u1ebfn c\u1ed1 HKTM \u1edf b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt thay th\u1ebf kh\u1edbp g\u1ed1i, kh\u1edbp h\u00e1ng, rivaroxaban cho th\u1ea5y hi\u1ec7u qu\u1ea3 ph\u00f2ng ng\u1eeba HKTM t\u1ed1t v\u1edbi bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft t\u01b0\u01a1ng \u0111\u01b0\u01a1ng enoxaparin.<\/li>\n<li>Li\u1ec1u d\u00f9ng: Rivaroxaban 10 mg 1 l\u1ea7n\/24h. Li\u1ec1u \u0111\u1ea7u ti\u00ean sau ph\u1eabu thu\u1eadt t\u1eeb 1-4h v\u1edbi t\u00ecnh tr\u1ea1ng c\u1ea7m m\u00e1u \u1ed5n \u0111\u1ecbnh. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb l\u00e0 2 tu\u1ea7n v\u1edbi ph\u1eabu thu\u1eadt thay th\u1ebf kh\u1edbp g\u1ed1i v\u00e0 5 tu\u1ea7n v\u1edbi ph\u1eabu thu\u1eadt thay th\u1ebf kh\u1edbp h\u00e1ng.<\/li>\n<li>B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean: Trong m\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean, m\u00f9 \u0111\u00f4i g\u1ed3m 27395 b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean \u1ed5n \u0111\u1ecbnh, k\u1ebft qu\u1ea3 cho th\u1ea5y d\u00f9ng rivaroxaban 2,5 mg x 2 l\u1ea7n\/24h k\u1ebft h\u1ee3p aspirin gi\u00fap gi\u1ea3m bi\u1ebfn c\u1ed1 tim m\u1ea1ch t\u1ed1t h\u01a1n d\u00f9ng aspirin \u0111\u01a1n \u0111\u1ed9c nh\u01b0ng t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft n\u1eb7ng l\u1ea1i cao h\u01a1n. Nh\u00f3m ch\u1ec9 d\u00f9ng rivaroxaban 5 mg x 2 l\u1ea7n\/24h kh\u00f4ng t\u1ed1t h\u01a1n d\u00f9ng aspirin \u0111\u01a1n thu\u1ea7n v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u cao h\u01a1n. D\u00f9 v\u1eady, t\u1ef7 l\u1ec7 t\u1eed vong do xu\u1ea5t huy\u1ebft kh\u00f4ng t\u0103ng. K\u1ebft qu\u1ea3 c\u0169ng cho th\u1ea5y li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p n\u00e0y c\u1ea3i thi\u1ec7n l\u1ee3i \u00edch l\u00e2m s\u00e0ng g\u1ed9p so v\u1edbi aspirin \u0111\u01a1n thu\u1ea7n. Cu\u1ed1i c\u00f9ng, li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p n\u00e0y gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n so v\u1edbi aspirin \u0111\u01a1n thu\u1ea7n.<\/li>\n<li>H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n (theo ESC 2019): Tr\u00ean b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim tr\u00ean 1 n\u0103m ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng lan t\u1ecfa \u0111a th\u00e2n \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, k\u00e8m nh\u1ecbp xoang:<\/li>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 bi\u1ebfn c\u1ed1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 cao v\u00e0 kh\u00f4ng c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft cao: C\u1ea7n c\u00e2n nh\u1eafc vi\u1ec7c th\u00eam m\u1ed9t thu\u1ed1c kh\u00e1ng huy\u1ebft kh\u1ed1i nh\u01b0 l\u00e0 rivaroxaban 2,5 mg x 2 l\u1ea7n\/24h c\u00f9ng v\u1edbi aspirin \u0111\u1ec3 d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t l\u00e2u d\u00e0i (IIa, A).<\/li>\n<li>Nguy c\u01a1 bi\u1ebfn c\u1ed1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 cao \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a: T\u1ed5n th\u01b0\u01a1ng lan t\u1ecfa \u0111a th\u00e2n \u0111\u1ed9ng m\u1ea1ch v\u00e0nh k\u00e8m m\u1ed9t trong c\u00e1c b\u1ec7nh l\u00fd sau: \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c; nh\u1ed3i m\u00e1u c\u01a1 tim t\u00e1i ph\u00e1t; b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean; suy tim; suy th\u1eadn v\u1edbi MLCT 15 \u2013 59 mL\/ph\u00fat.<\/li>\n<li>Nguy c\u01a1 xu\u1ea5t huy\u1ebft cao \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a: Ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd ho\u1eb7c c\u00e1c b\u1ec7nh l\u00fd n\u1ed9i s\u1ecd kh\u00e1c; xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a g\u1ea7n \u0111\u00e2y ho\u1eb7c thi\u1ebfu m\u00e1u do xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a; c\u00e1c b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft; suy gan; b\u1ec7nh l\u00fd \u0111\u00f4ng m\u00e1u; tu\u1ed5i cao ho\u1eb7c suy ki\u1ec7t; suy th\u1eadn c\u1ea7n l\u1ecdc m\u00e1u ho\u1eb7c MLCT &lt; 15 mL\/ph\u00fat.<\/li>\n<li>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng (theo ESC 2019): \u1ede b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng k\u00e8m b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch chi d\u01b0\u1edbi c\u00f3 tri\u1ec7u ch\u1ee9ng, kh\u00f4ng c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft cao, ph\u1ed1i h\u1ee3p rivaroxaban 2,5 mg x 2 l\u1ea7n\/24h v\u1edbi aspirin n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc (IIa, B).<\/li>\n<\/ul>\n<h3>1.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h3>\n<ul>\n<li>Qu\u00e1 m\u1eabn v\u1edbi rivaroxaban. Ch\u1ea3y m\u00e1u n\u1eb7ng.<\/li>\n<li>Suy gan, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u. Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa.<\/li>\n<\/ul>\n<h3>1.4. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/h3>\n<p>C\u1ea7n d\u00f9ng rivaroxaban th\u1eadn tr\u1ecdng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ch\u1ed1ng n\u1ea5m\u00a0 (v\u00ed d\u1ee5 ketoconazole), ritonavir, rifampicin.<\/p>\n<h2><strong>2.Dabigatran<\/strong><\/h2>\n<p>L\u00e0 thu\u1ed1c thu\u1ed9c nh\u00f3m NOAC n\u00ean c\u01a1 ch\u1ebf c\u0169ng t\u01b0\u01a1ng t\u1ef1 \u0111\u00e3 n\u00eau tr\u00ean. C\u00e1c ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u d\u00f9ng c\u1ee7a lo\u1ea1i NOAC d\u01b0\u1edbi \u0111\u00e2y:<\/p>\n<h3>2.1 Ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u l\u01b0\u1ee3ng<\/h3>\n<ul>\n<li>Rung nh\u0129 kh\u00f4ng do b\u1ec7nh van tim<\/li>\n<li>Li\u1ec1u cao h\u01a1n l\u00e0 150 mg hai l\u1ea7n\/24h gi\u1ea3m \u0111\u00e1ng k\u1ec3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 n\u00e3o\/thuy\u00ean t\u1eafc h\u1ec7 th\u1ed1ng nh\u01b0ng ch\u1ea3y m\u00e1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi warfarin.<\/li>\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u1ea7n \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ed1t rung nh\u0129 qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng, nghi\u00ean c\u1ee9u RECIRCUIT \u0111\u00e3 cho th\u1ea5y kh\u00f4ng c\u1ea7n gi\u00e1n \u0111o\u1ea1n dabigatran trong qu\u00e1 tr\u00ecnh tri\u1ec7t \u0111\u1ed1t, dabigatran gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u n\u1eb7ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea so v\u1edbi warfarin v\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 \u0111\u1ed9t qu\u1ef5 ho\u1eb7c thuy\u00ean t\u1eafc h\u1ec7 th\u1ed1ng trong qu\u00e1 tr\u00ecnh tri\u1ec7t \u0111\u1ed1t.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u (DVT) c\u1ea5p v\u00e0\/ho\u1eb7c thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PE) v\u00e0 ng\u0103n ng\u1eeba t\u1eed vong li\u00ean quan. Dabigatran 150 mg, u\u1ed1ng 2 l\u1ea7n\/24h sau khi \u0111i\u1ec1u tr\u1ecb v\u1edbi m\u1ed9t thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam trong \u00edt nh\u1ea5t 5 ng\u00e0y. N\u00ean ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb cho \u0111\u1ebfn 3 th\u00e1ng. Kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i ch\u1ec9nh li\u1ec1u \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn c\u00f3 MLCT &gt;30 mL\/ph\u00fat.<\/li>\n<li>Ph\u00f2ng ng\u1eeba DVT v\u00e0\/ho\u1eb7c PE t\u00e1i ph\u00e1t v\u00e0 t\u1eed vong li\u00ean quan.Dabigatran 150mg, u\u1ed1ng 2 l\u1ea7n\/24h. \u0110i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u00f9y thu\u1ed9c nguy c\u01a1 c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n. B\u1ec7nh nh\u00e2n suy th\u1eadn trung b\u00ecnh (MLCT 30 \u2013 50 mL\/ph\u00fat): n\u00ean \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn \u00edt nh\u1ea5t 1 l\u1ea7n\/n\u0103m. Kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i ch\u1ec9nh li\u1ec1u \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn c\u00f3 MLCT &gt;30 mL\/ph\u00fat.<\/li>\n<li>Tr\u1ebb &lt;18 tu\u1ed5i: Kh\u00f4ng khuy\u1ebfn c\u00e1o.<\/li>\n<li>Ph\u00f2ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (HKTM) sau ph\u1eabu thu\u1eadt thay th\u1ebf kh\u1edbp g\u1ed1i:N\u00ean u\u1ed1ng 1 vi\u00ean 110 mg trong v\u00f2ng 1 \u2013 4h sau ph\u1eabu thu\u1eadt, sau \u0111\u00f3 ti\u1ebfp t\u1ee5c 2 vi\u00ean x 1 l\u1ea7n\/24h trong 10 ng\u00e0y. N\u1ebfu vi\u1ec7c c\u1ea7m m\u00e1u ch\u01b0a \u0111\u01b0\u1ee3c b\u1ea3o \u0111\u1ea3m, n\u00ean tr\u00ec ho\u00e3n kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. N\u1ebfu kh\u00f4ng b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c ngay trong ng\u00e0y ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt, n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb sau \u0111\u00f3 v\u1edbi 2 vi\u00ean 110 mg, m\u1ed9t l\u1ea7n\/24h.<\/li>\n<li>Ph\u00f2ng HKTM sau ph\u1eabu thu\u1eadt thay kh\u1edbp h\u00e1ng:N\u00ean u\u1ed1ng 1 vi\u00ean 110mg trong v\u00f2ng 1 \u2013 4h sau ph\u1eabu thu\u1eadt, sau \u0111\u00f3 ti\u1ebfp t\u1ee5c 2 vi\u00ean x 1 l\u1ea7n\/24h trong 4 \u0111\u1ebfn 5 tu\u1ea7n. N\u1ebfu vi\u1ec7c c\u1ea7m m\u00e1u ch\u01b0a \u0111\u01b0\u1ee3c b\u1ea3o \u0111\u1ea3m, n\u00ean tr\u00ec ho\u00e3n kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. N\u1ebfu kh\u00f4ng d\u00f9ng thu\u1ed1c ngay trong ng\u00e0y ph\u1eabu thu\u1eadt th\u00ec n\u00ean b\u1eaft \u0111\u1ea7u sau \u0111\u00f3 2 vi\u00ean 110 mg x 1 l\u1ea7n\/24h. Gi\u1ea3m li\u1ec1u c\u00f2n 150 mg\/24h \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn trung b\u00ecnh ho\u1eb7c ng\u01b0\u1eddi cao tu\u1ed5i (&gt;75 tu\u1ed5i).<\/li>\n<\/ul>\n<h3>2.2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h3>\n<ul>\n<li>Qu\u00e1 m\u1eabn v\u1edbi th\u00e0nh ph\u1ea7n thu\u1ed1c. Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa. Suy th\u1eadn n\u1eb7ng, suy gan.<\/li>\n<li>\u0110ang c\u00f3 t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u ti\u1ebfn tri\u1ec3n.<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng c\u01a1 quan c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao, bao g\u1ed3m \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft trong v\u00f2ng 6 th\u00e1ng.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi ketoconazole to\u00e0n th\u00e2n, cyclosporin, itraconazole, dronedarone, thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1c.<\/li>\n<\/ul>\n<h3>2.3. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/h3>\n<p>Tr\u00e1nh d\u00f9ng \u0111\u1ed3ng th\u1eddi dabigatran v\u1edbi ch\u1ea5t c\u1ea3m \u1ee9ng P-glycoprotein nh\u01b0 rifampicin. Tr\u00e1nh d\u00f9ng ho\u1eb7c gi\u1ea3m li\u1ec1u dabigatran c\u00f9ng v\u1edbi c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf P-glycoprotein \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn CrCl 30 \u2013 50 mL\/ph\u00fat. Kh\u00f4ng khuy\u1ebfn c\u00e1o d\u00f9ng c\u00f9ng c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf P-glycoprotein \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn CrCl &lt;30 mL\/ph\u00fat.<\/p>\n<h3>2.4. Th\u1eadn tr\u1ecdng<\/h3>\n<p>B\u1ec7nh nh\u00e2n suy th\u1eadn, \u226575 tu\u1ed5i, s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi ch\u1ea5t \u1ee9c ch\u1ebf m\u1ea1nh P-glycoprotein, ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a; chuy\u1ec3n \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb gi\u1eefa NOAC n\u00e0y v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng d\u1ea1ng ti\u00eam\/thu\u1ed1c \u0111\u1ed1i kh\u00e1ng vitamin K; ph\u1ea3i qua ph\u1eabu thu\u1eadt\/th\u1ee7 thu\u1eadt can thi\u1ec7p, g\u00e2y t\u00ea t\u1ee7y s\u1ed1ng\/ngo\u00e0i m\u00e0ng c\u1ee9ng, ch\u1ecdc d\u00f2 t\u1ee7y s\u1ed1ng; c\u00f3 thai\/cho con b\u00fa.<\/p>\n<h3>2.5. Thu\u1ed1c h\u00f3a gi\u1ea3i \u0111\u1eb7c hi\u1ec7u: Idarucizumab 2,5 g\/50 mL.<\/h3>\n<p>L\u00e0 thu\u1ed1c h\u00f3a gi\u1ea3i \u0111\u1eb7c hi\u1ec7u c\u1ee7a dabigatran, \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng dabigatran c\u1ea7n h\u00f3a gi\u1ea3i nhanh t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng m\u00e1u trong ph\u1eabu thu\u1eadt\/th\u1ee7 thu\u1eadt c\u1ea5p ho\u1eb7c tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u \u0111e d\u1ecda t\u00ednh m\u1ea1ng ho\u1eb7c kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c.<\/p>\n<p>Li\u1ec1u d\u00f9ng: 5 g (2 l\u1ecd 50 mL), 2 l\u1ea7n truy\u1ec1n li\u00ean t\u1ee5c trong 5 \u2013 10 ph\u00fat cho m\u1ed7i l\u1ea7n truy\u1ec1n ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch nhanh. C\u00e2n nh\u1eafc 5 g l\u1ea7n th\u1ee9 hai n\u1ebfu t\u00e1i ph\u00e1t ch\u1ea3y m\u00e1u k\u00e8m k\u00e9o d\u00e0i th\u1eddi gian \u0111\u00f4ng m\u00e1u ho\u1eb7c c\u00f3 y\u00eau c\u1ea7u ph\u1eabu thu\u1eadt c\u1ea5p c\u1ee9u l\u1ea7n hai\/th\u1ee7 thu\u1eadt kh\u1ea9n c\u1ea5p v\u00e0 th\u1eddi gian \u0111\u00f4ng m\u00e1u k\u00e9o d\u00e0i. \u0110i\u1ec1u tr\u1ecb l\u1ea1i b\u1eb1ng dabigatran 24h sau khi d\u00f9ng Idarucizumab n\u1ebfu t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh v\u00e0 \u0111\u00e3 c\u1ea7m m\u00e1u t\u1ed1t.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>NOAC (New Oral Anticoagulants) l\u00e0 m\u1ed9t nh\u00f3m thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u1edbi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn \u0111\u00f4ng m\u00e1u, nh\u01b0ng kh\u00e1c v\u1edbi heparin, ch\u00fang \u0111\u01b0\u1ee3c d\u00f9ng d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c u\u1ed1ng. C\u00e1c lo\u1ea1i NOAC g\u1ed3m: Rivaroxaban,Dabigatran&#8230; 1.Rivaroxaban Rivaroxaban l\u00e0 m\u1ed9t NOAC \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 t\u00e1c [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":22566,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NOAC thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t<\/title>\n<meta name=\"description\" content=\"NOAC thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t s\u1ebd \u0111\u01b0\u1ee3c l\u00e0m r\u00f5 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y t\u1eeb c\u01a1 ch\u1ebf \u0111\u1ebfn th\u1ef1c h\u00e0nh.\" \/>\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=\"NOAC thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t\" \/>\n<meta property=\"og:description\" content=\"NOAC thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t s\u1ebd \u0111\u01b0\u1ee3c l\u00e0m r\u00f5 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y t\u1eeb c\u01a1 ch\u1ebf \u0111\u1ebfn th\u1ef1c h\u00e0nh.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-17T00:58:48+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-17T03:56:20+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/201405Brieger-fig1.gif\" \/>\n\t<meta property=\"og:image:width\" content=\"415\" \/>\n\t<meta property=\"og:image:height\" content=\"292\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/gif\" \/>\n<meta name=\"author\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/\",\"name\":\"NOAC thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-17T00:58:48+00:00\",\"dateModified\":\"2023-04-17T03:56:20+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/dded5c0d4cb1bb77d05cf29ab5f85629\"},\"description\":\"NOAC thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t s\u1ebd \u0111\u01b0\u1ee3c l\u00e0m r\u00f5 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y t\u1eeb c\u01a1 ch\u1ebf \u0111\u1ebfn th\u1ef1c h\u00e0nh.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/noac-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"NOAC (New Oral Anticoagulants) &#8211; 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