{"id":22590,"date":"2023-04-17T07:57:54","date_gmt":"2023-04-17T00:57:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22590"},"modified":"2023-04-17T10:57:36","modified_gmt":"2023-04-17T03:57:36","slug":"thuoc-khang-vitamin-k-va-nhung-dieu-can-biet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/thuoc-khang-vitamin-k-va-nhung-dieu-can-biet\/","title":{"rendered":"Thu\u1ed1c kh\u00e1ng vitamin K v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft"},"content":{"rendered":"

Thu\u1ed1c kh\u00e1ng vitamin K (Vitamin K antagonist \u2013 VKA) l\u00e0 nh\u00f3m thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t trong s\u1ed1 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng. C\u00e1c thu\u1ed1c VKA h\u1ea7u nh\u01b0 c\u00f3 r\u1ea5t \u00edt t\u00e1c d\u1ee5ng ph\u1ee5.<\/strong><\/p>\n

1.C\u00e1c thu\u1ed1c nh\u00f3m kh\u00e1ng vitamin K<\/strong><\/h2>\n\n\n\n\n\n\n
T\u00ean d\u01b0\u1ee3c ch\u1ea5t<\/td>\nT\u00ean th\u01b0\u01a1ng m\u1ea1i<\/td>\nTh\u1eddi gian b\u00e1n h\u1ee7y<\/td>\n<\/tr>\n
Acenocoumarol<\/td>\nSintrom 4 mg Minisintrom 1 mg Aceronko 4 mg<\/td>\n8-10h<\/td>\n<\/tr>\n
Warfarin<\/td>\nCoumadine 2 mg Coumadine 5 mg<\/td>\n36-45h<\/td>\n<\/tr>\n
Fluindione<\/td>\nPreviscan 20 mg<\/td>\n31h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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

Thu\u1ed1c\u00a0 kh\u00e1ng vitamin K c\u00f3 t\u00e1c d\u1ee5ng b\u1ea5t ho\u1ea1t vitamin K trong ty th\u1ec3 \u1edf gan, d\u1eabn \u0111\u1ebfn gi\u1ea3m h\u00ecnh th\u00e0nh c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u ph\u1ee5 thu\u1ed9c vitamin K, v\u00ed d\u1ee5 nh\u01b0 prothrombin. Th\u00eam v\u00e0o \u0111\u00f3, c\u0169ng c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m y\u1ebfu t\u1ed1 X. Sau 2-7 ng\u00e0y k\u1ec3 t\u1eeb khi u\u1ed1ng thu\u1ed1c, t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng m\u00e1u m\u1edbi xu\u1ea5t hi\u1ec7n.<\/p>\n

3.Ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c kh\u00e1ng vitamin K<\/strong><\/h2>\n
    \n
  • D\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 do b\u1ec7nh van tim v\u00e0 kh\u00f4ng do b\u1ec7nh van tim.<\/li>\n
  • Thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/li>\n
  • D\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch sau ph\u1eabu thu\u1eadt kh\u1edbp h\u00e1ng, kh\u1edbp g\u1ed1i. Van tim c\u01a1 h\u1ecdc nh\u00e2n t\u1ea1o.<\/li>\n
  • Van tim sinh h\u1ecdc trong 3 th\u00e1ng \u0111\u1ea7u.<\/li>\n<\/ul>\n

    4.Li\u1ec1u d\u00f9ng<\/strong><\/h2>\n
      \n
    • Li\u1ec1u kh\u1edfi \u0111\u1ea7u n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a t\u00f9y theo \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n (v\u00ed d\u1ee5: ch\u1ee9c n\u0103ng gan th\u1eadn, tu\u1ed5i, t\u00ecnh tr\u1ea1ng dinh d\u01b0\u1ee1ng, nguy c\u01a1 ch\u1ea3y m\u00e1u\u2026). Warfarin th\u01b0\u1eddng \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u 2-5 mg\/24h trong 5 ng\u00e0y, acenocoumarol (Sintrom) th\u01b0\u1eddng \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u 1 mg\/24h.<\/li>\n
    • Ki\u1ec3m tra x\u00e9t nghi\u1ec7m PT-INR h\u1eb1ng ng\u00e0y ho\u1eb7c c\u00e1ch ng\u00e0y cho \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c PT-INR trong kho\u1ea3ng \u0111i\u1ec1u tr\u1ecb. Trong 2 tu\u1ea7n ti\u1ebfp theo, c\u00f3 th\u1ec3 ki\u1ec3m tra PT-INR c\u00e1ch ng\u00e0y \u0111\u1ec3 gi\u00e1m s\u00e1t PT-INR c\u00f3 n\u1eb1m trong kho\u1ea3ng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb hay kh\u00f4ng.<\/li>\n
    • \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n cao tu\u1ed5i v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao ch\u1ea3y m\u00e1u n\u00ean gi\u1ea3m li\u1ec1u \u0111i\u1ec1u tr\u1ecb kh\u1edfi \u0111\u1ea7u (v\u00ed d\u1ee5: acenocoumarol 0,5 mg\/24h). Do s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 gen quy \u0111\u1ecbnh ho\u1ea1t \u0111\u1ed9ng enzyme \u1edf gan gi\u1eefa c\u00e1c ch\u1ee7ng t\u1ed9c ch\u00e2u \u00c1, ch\u00e2u Phi v\u00e0 Do Th\u00e1i, do \u0111\u00f3 n\u00ean kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n ch\u00e2u \u00c1 v\u00e0 c\u00f3 th\u1ec3 kh\u1edfi \u0111\u1ea7u li\u1ec1u cao h\u01a1n \u1edf ng\u01b0\u1eddi ch\u00e2u Phi v\u00e0 Do Th\u00e1i.<\/li>\n
    • \u0110\u1ec3 b\u1eafc c\u1ea7u sang thu\u1ed1c VKA \u0111\u01b0\u1eddng u\u1ed1ng \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng heparin, n\u00ean kh\u1edfi \u0111\u1ea7u thu\u1ed1c VKA \u00edt nh\u1ea5t kho\u1ea3ng 3-4 ng\u00e0y tr\u01b0\u1edbc khi ng\u1eebng heparin \u0111\u1ec3 c\u00f3 th\u1eddi gian b\u1ea5t ho\u1ea1t c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u ph\u1ee5 thu\u1ed9c vitamin K trong tu\u1ea7n ho\u00e0n. C\u00f3 th\u1ec3 ng\u1eebng heparin khi PT-INR \u0111\u00e3 \u0111\u1ea1t kho\u1ea3ng \u0111i\u1ec1u tr\u1ecb trong 2 ng\u00e0y li\u00ean ti\u1ebfp.<\/li>\n
    • Kh\u00f4ng n\u00ean kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u qu\u00e1 cao \u0111\u1ec3 tr\u00e1nh t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng m\u00e1u qu\u00e1 m\u1ee9c, s\u1ebd g\u00e2y ch\u1ea3y m\u00e1u. B\u1ec7nh nh\u00e2n c\u00f3 suy tim v\u00e0 b\u1ec7nh gan n\u00ean kh\u1edfi \u0111\u1ea7u v\u00e0 duy tr\u00ec li\u1ec1u th\u1ea5p. T\u00ecnh tr\u1ea1ng kh\u00e1ng thu\u1ed1c VKA th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn y\u1ebfu t\u1ed1 gen. Vi\u1ec7c ch\u1ec9nh li\u1ec1u VKA c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a \u1edf t\u1eebng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3.<\/li>\n<\/ul>\n

      5.M\u1ee5c ti\u00eau PT-INR \u0111i\u1ec1u tr\u1ecb<\/strong><\/h2>\n
        \n
      • T\u00e1c d\u1ee5ng c\u1ee7a VKA \u0111\u01b0\u1ee3c theo d\u00f5i b\u1eb1ng c\u00e1ch x\u00e9t nghi\u1ec7m ch\u1ec9 s\u1ed1 PT-INR.<\/li>\n
      • Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng n\u00f3i chung, m\u1ee5c ti\u00eau PT-INR c\u1ea7n \u0111\u1ea1t l\u00e0 t\u1eeb 2,0-3,0. \u0110\u00e2y l\u00e0 kho\u1ea3ng PT-INR ph\u00f9 h\u1ee3p cho m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd nh\u01b0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi, thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, rung nh\u0129.<\/li>\n
      • \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n mang van tim nh\u00e2n t\u1ea1o, m\u1ee9c ch\u1ed1ng \u0111\u00f4ng \u0111\u00f2i h\u1ecfi cao h\u01a1n v\u1edbi m\u1ee5c ti\u00eau PT-INR 2,5-3,5 t\u00f9y lo\u1ea1i van tim c\u1ee5 th\u1ec3. Trong \u0111\u00f3, n\u1ebfu b\u1ec7nh nh\u00e2n mang van sinh h\u1ecdc ho\u1eb7c van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u01a1 h\u1ecdc, m\u1ee9c PT-INR \u0111\u00f2i h\u1ecfi th\u1ea5p h\u01a1n (2,0-3,0), c\u00f2n b\u1ec7nh nh\u00e2n mang van hai l\u00e1 c\u01a1 h\u1ecdc c\u1ea7n m\u1ee9c PT-INR m\u1ee5c ti\u00eau cao h\u01a1n (th\u01b0\u1eddng 2,5-3,5).<\/li>\n
      • \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ch\u00e2u \u00c1, m\u1ee9c PT-INR m\u1ee5c ti\u00eau n\u00ean \u0111\u1eb7t ra th\u1ea5p h\u01a1n m\u1ed9t ch\u00fat do nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd cao h\u01a1n. Khi t\u00ecnh tr\u1ea1ng ch\u1ed1ng \u0111\u00f4ng \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u01b0\u01a1ng \u0111\u1ed1i \u1ed5n \u0111\u1ecbnh, c\u00f3 th\u1ec3 gi\u00e3n kho\u1ea3ng c\u00e1ch x\u00e9t nghi\u1ec7m PT-INR t\u1edbi kho\u1ea3ng 4-6 tu\u1ea7n\/l\u1ea7n.<\/li>\n
      • L\u01b0u \u00fd l\u00e0 PT-INR c\u00f3 th\u1ec3 dao \u0111\u1ed9ng th\u1ea5t th\u01b0\u1eddng do chuy\u1ec3n h\u00f3a thu\u1ed1c VKA c\u00f3 th\u1ec3 b\u1ecb t\u00e1c \u0111\u1ed9ng b\u1edfi th\u1ee9c \u0103n, r\u01b0\u1ee3u bia v\u00e0 c\u00e1c thu\u1ed1c u\u1ed1ng k\u00e8m kh\u00e1c.<\/li>\n<\/ul>\n

        6.C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n gi\u1ea3m li\u1ec1u thu\u1ed1c VKA<\/strong><\/h2>\n
          \n
        • Li\u1ec1u thu\u1ed1c VKA n\u00ean gi\u1ea3m \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim sung huy\u1ebft, suy gan do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o bao g\u1ed3m c\u1ea3 do r\u01b0\u1ee3u, suy th\u1eadn, suy dinh d\u01b0\u1ee1ng (do b\u1ea3n th\u00e2n b\u1ec7nh nh\u00e2n \u0111\u00e3 thi\u1ebfu h\u1ee5t vitamin K s\u1eb5n). T\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p l\u00e0m t\u0103ng d\u1ecb h\u00f3a vitamin K, do \u0111\u00f3 c\u0169ng c\u1ea7n gi\u1ea3m li\u1ec1u thu\u1ed1c VKA.<\/li>\n
        • B\u1ec7nh nh\u00e2n cao tu\u1ed5i \u0111\u00e1p \u1ee9ng nhanh h\u01a1n v\u1edbi thu\u1ed1c VKA, do \u0111\u00f3 c\u0169ng c\u1ea7n kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p v\u00e0 t\u0103ng li\u1ec1u th\u1eadn tr\u1ecdng.<\/li>\n
        • B\u1ec7nh nh\u00e2n c\u00f3 ch\u1ebf \u0111\u1ed9 \u0103n nhi\u1ec1u vitamin K (v\u00ed d\u1ee5, c\u00e1c lo\u1ea1i rau h\u1ecd c\u1ea3i, s\u00fap l\u01a1 xanh\u2026) s\u1ebd l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c VKA. Nh\u1eefng b\u1ec7nh nh\u00e2n thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 \u0103n rau li\u00ean t\u1ee5c, l\u00fac nhi\u1ec1u l\u00fac \u00edt, s\u1ebd l\u00e0m PT-INR dao \u0111\u1ed9ng nhi\u1ec1u.<\/li>\n<\/ul>\n

          7.C\u00e1c thu\u1ed1c t\u01b0\u01a1ng t\u00e1c v\u1edbi VKA<\/strong><\/h2>\n
            \n
          • Thu\u1ed1c VKA t\u01b0\u01a1ng t\u00e1c v\u1edbi kho\u1ea3ng 80 lo\u1ea1i thu\u1ed1c kh\u00e1c.<\/li>\n
          • M\u1ed9t s\u1ed1 thu\u1ed1c nh\u00f3m barbiturate, phenytoin \u1ee9c ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a VKA do l\u00e0m t\u0103ng gi\u00e1ng h\u00f3a VKA \u1edf gan. M\u1ed9t s\u1ed1 thu\u1ed1c l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a VKA nh\u01b0 allopurinol, amiodarone v\u00e0 c\u00e1c cephalosporin. M\u1ed9t s\u1ed1 thu\u1ed1c l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 gi\u00e1ng h\u00f3a c\u1ee7a VKA v\u00e0 do \u0111\u00f3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng v\u00ed d\u1ee5 nh\u01b0 metronidazole v\u00e0 cotrimoxazole.<\/li>\n
          • C\u00e1c thu\u1ed1c ch\u1ed1ng ng\u01b0ng t\u1eadp ti\u1ec3u c\u1ea7u nh\u01b0 aspirin, clopidogrel, thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng glucocorticoid khi d\u00f9ng chung v\u1edbi thu\u1ed1c VKA c\u00f3 th\u1ec3 l\u00e0m gia t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft.<\/li>\n
          • C\u00e1c b\u1ec7nh nh\u00e2n \u0111ang u\u1ed1ng VKA kh\u00f4ng n\u00ean t\u1ef1 \u00fd mua c\u00e1c thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n v\u1ec1 u\u1ed1ng v\u00e0 c\u1ea7n h\u1ecfi \u00fd ki\u1ebfn b\u00e1c s\u0129 khi d\u1ef1 \u0111\u1ecbnh u\u1ed1ng m\u1ed9t lo\u1ea1i thu\u1ed1c m\u1edbi n\u00e0o \u0111\u00f3. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 s\u1ef1 thay \u0111\u1ed5i ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng (v\u00ed d\u1ee5: \u0111i c\u00f4ng t\u00e1c ho\u1eb7c du l\u1ecbch d\u00e0i ng\u00e0y) n\u00ean th\u1eadn tr\u1ecdng x\u00e9t nghi\u1ec7m PT-INR th\u01b0\u1eddng xuy\u00ean h\u01a1n \u0111\u1ec3 hi\u1ec7u ch\u1ec9nh li\u1ec1u thu\u1ed1c VKA.<\/li>\n<\/ul>\n

            8.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a VKA<\/strong><\/h2>\n

            C\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh bao g\u1ed3m: M\u1edbi \u0111\u1ed9t qu\u1ef5 n\u00e3o, huy\u1ebft \u00e1p kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c, x\u01a1 gan, c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a ho\u1eb7c xu\u1ea5t huy\u1ebft ti\u1ebft ni\u1ec7u. N\u1ebfu ch\u1ec9 \u0111\u1ecbnh d\u00f9ng ch\u1ed1ng \u0111\u00f4ng l\u00e0 c\u1ea7n thi\u1ebft n\u00ean t\u00ednh to\u00e1n k\u1ef9 l\u1ee3i \u00edch \u2013 nguy c\u01a1 tr\u01b0\u1edbc khi ch\u1ec9 \u0111\u1ecbnh. B\u1ec7nh nh\u00e2n cao tu\u1ed5i kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a VKA, tuy nhi\u00ean b\u1ec7nh nh\u00e2n cao tu\u1ed5i l\u00e0 \u0111\u1ed1i t\u01b0\u1ee3ng d\u1ec5 b\u1ecb xu\u1ea5t huy\u1ebft h\u01a1n, nh\u1ea5t l\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 d\u1ec5 ng\u00e3, do \u0111\u00f3 c\u1ea7n th\u1eadn tr\u1ecdng ch\u1ec9 \u0111\u1ecbnh VKA \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i.<\/p>\n

            9.Qu\u00e1 m\u1ee9c ch\u1ed1ng \u0111\u00f4ng do d\u00f9ng thu\u1ed1c VKA<\/strong><\/h2>\n

            9.1. N\u1ebfu \u0111ang c\u00f3 ch\u1ea3y m\u00e1u n\u1eb7ng<\/h3>\n
              \n
            • \u0110\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o, ch\u1ea3y m\u00e1u sau ph\u00fac m\u1ea1c v\u00e0 b\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u n\u00e0o c\u00f3 th\u1ec3 d\u1eabn t\u1edbi t\u1eed vong, nh\u1eadp vi\u1ec7n ho\u1eb7c ph\u1ea3i truy\u1ec1n m\u00e1u.<\/li>\n
            • C\u1ea7n ng\u1eebng VKA. 5-10 mg vitamin K1 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (\u0111\u1ec3 tr\u00e1nh nguy c\u01a1 ph\u1ea3n v\u1ec7 n\u00ean pha lo\u00e3ng trong kho\u1ea3ng 50 mL NaCl 0,9% ho\u1eb7c glucose 5% v\u00e0 truy\u1ec1n TM ch\u1eadm trong \u00edt nh\u1ea5t 20 ph\u00fat).<\/li>\n
            • Truy\u1ec1n t\u0129nh m\u1ea1ch 2-4 \u0111\u01a1n v\u1ecb huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh c\u00f9ng nh\u00f3m. Ki\u1ec3m tra PT-INR li\u00ean t\u1ee5c cho \u0111\u1ebfn khi ng\u1eebng ch\u1ea3y m\u00e1u.<\/li>\n<\/ul>\n

              9.2. N\u1ebfu kh\u00f4ng c\u00f3 ch\u1ea3y m\u00e1u ho\u1eb7c ch\u1ea3y m\u00e1u nh\u1eb9<\/h3>\n
                \n
              • PT-INR < 6,0: T\u1ea1m ng\u1eebng VKA trong 1-2 ng\u00e0y. Sau \u0111\u00f3 b\u1eaft \u0111\u1ea7u l\u1ea1i v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n.<\/li>\n
              • PT-INR trong kho\u1ea3ng 6,0-10,0: T\u1ea1m ng\u1eebng VKA \u00edt nh\u1ea5t 1-2 ng\u00e0y. C\u00f3 th\u1ec3 cho vitamin K \u0111\u01b0\u1eddng u\u1ed1ng 1-2,5 mg n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao. U\u1ed1ng l\u1ea1i VKA v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n khi th\u1ea5y PT-INR v\u1ec1 kho\u1ea3ng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng.<\/li>\n
              • PT-INR >10,0: T\u1ea1m ng\u1eebng thu\u1ed1c VKA v\u00e0i ng\u00e0y. C\u00f3 th\u1ec3 cho vitamin K \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam vitamin K1 t\u0129nh m\u1ea1ch 2,5-5 mg n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao. U\u1ed1ng l\u1ea1i VKA v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n khi PT-INR v\u1ec1 kho\u1ea3ng m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng. Kh\u00f4ng c\u1ea7n truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p do b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch ch\u01b0a r\u00f5 r\u00e0ng, trong khi \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i, t\u00e1c d\u1ee5ng ph\u1ee5 li\u00ean quan \u0111\u1ebfn truy\u1ec1n m\u00e1u\u2026<\/li>\n<\/ul>\n

                L\u01b0u \u00fd: \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n mang van tim nh\u00e2n t\u1ea1o n\u00ean tr\u00e1nh d\u00f9ng vitamin K1 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch tr\u1eeb khi \u0111ang c\u00f3 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd \u0111e d\u1ecda t\u00ednh m\u1ea1ng, v\u00ec vitamin K1 l\u00e0m t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i van nh\u00e2n t\u1ea1o sau \u0111\u00f3. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u00ean s\u1eed d\u1ee5ng huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh.<\/p>\n","protected":false},"excerpt":{"rendered":"

                Thu\u1ed1c kh\u00e1ng vitamin K (Vitamin K antagonist \u2013 VKA) l\u00e0 nh\u00f3m thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t trong s\u1ed1 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng. C\u00e1c thu\u1ed1c VKA h\u1ea7u nh\u01b0 c\u00f3 r\u1ea5t \u00edt t\u00e1c d\u1ee5ng ph\u1ee5. 1.C\u00e1c thu\u1ed1c nh\u00f3m kh\u00e1ng vitamin K T\u00ean d\u01b0\u1ee3c ch\u1ea5t T\u00ean th\u01b0\u01a1ng m\u1ea1i Th\u1eddi gian b\u00e1n h\u1ee7y […]<\/p>\n","protected":false},"author":7,"featured_media":22593,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nThu\u1ed1c kh\u00e1ng vitamin K v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c kh\u00e1ng vitamin K v\u00e0 nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft s\u1ebd c\u00f3 trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y t\u1eeb c\u01a1 ch\u1ebf \u0111\u1ebf x\u1eed tr\u00ed c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta 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