Analysis for anti-ha activity. Analysis of anti-ha activity Stagnation in a child's life

Diyucha rechovina

Nadroparin calcium

Form vipusku, warehouse and packaging

Rozchin for n / a introduction

Additional words: solution of calcium hydroxide and hydrochloric acid (up to pH 5.0-7.5), water d / і (up to 0.3 ml).

0.3 ml - single-dose syringes (2) - blister (1) - packs of cardboard.
0.3 ml - single-dose syringes (2) - blisters (5) - packs of cardboard.

Rozchin for n / a introduction insight, slightly opalescent, without barn or light-colored color.

Additional words: solution of calcium hydroxide and hydrochloric acid (up to pH 5.0-7.5), water d / i (up to 0.4 ml).

0.4 ml - single-dose syringes (2) - blister (1) - packs of cardboard.
0.4 ml - single dose syringes (2) - blister (5) - packs of cardboard.

Rozchin for n / a introduction insight, slightly opalescent, without barn or light-colored color.

Additional words: solution of calcium hydroxide and hydrochloric acid (up to pH 5.0-7.5), water d / i (up to 0.6 ml).

0.6 ml - single-dose syringes (2) - blisters (1) - packs of cardboard.
0.6 ml - single-dose syringes (2) - blisters (5) - packs of cardboard.

Rozchin for n / a introduction insight, slightly opalescent, without barn or light-colored color.

Additional words: solution of calcium hydroxide and hydrochloric acid (up to pH 5.0-7.5), water d / i (up to 0.8 ml).

0.8 ml - single dose syringes (2) - blister (1) - packs of cardboard.
0.8 ml - single-dose syringes (2) - blisters (5) - packs of cardboard.

Rozchin for n / a introduction insight, slightly opalescent, without barn or light-colored color.

Additional words: solution of calcium hydroxide and hydrochloric acid (up to pH 5.0-7.5), water d / i (up to 1 ml).

1 ml - single-dose syringes (2) - blisters (1) - packs of cardboard.
1 ml - single-dose syringes (2) - blister (5) - packs of cardboard.

Pharmacological diya

Calcium nadroparin is a low molecular weight (LMWH), depolymerization by means of a standard heparin, є glucose aminoglycans from an average molecular weight 4300 daltons.

Viyavlyak is very good until you get sick with white blood with antithrombin III (AT III). Tse zyazuvannya to produce the accelerated reduction of factor Xa, which is a high antithrombotic potential of nadroparin.

INSHI mehanіzmi scho zabezpechuyut antitrombotichny efekt nadroparin, vklyuchayut aktivatsіyu іngіbіtoru peretvorennya tkaninnogo factor (TFPI), aktivatsіyu fіbrinolіzu for dopomoga vivіlnennya direct activator of tkaninnogo plazmіnogenu endotelіalnih klіtin i modifіkatsіyu reologіchnih vlastivostey krovі (znizhennya v'yazkostі krovі i zbіlshennya proniknostі membranes trombotsitіv granulotsitіv i) ...

Nadroparin calcium is characterized by a higher anti-Xa factor activity in proportion to the anti-IIa factor, or anti-thrombotic activity and volodymy as innocent, as well as continued anti-thrombotic activity.

In patients with non-fractional heparin, nadroparin is a smaller infusion on the function of thrombocytes and on aggregation and a small amount of infusion on the primary hemostasis.

At prophylactic doses, nadroparin does not have a pronounced decrease in APHT.

With a course lіkuvannі in the period of maximum activity, it is possible to increase the APHT to a value that is 1.4 times higher than the standard. Also prolonging the appearance of an excessive antithrombotic effect of nadroparin calcium.

Pharmacokinetics

Pharmacokinetic power is based on the anti-Xa factor activity of plasmas.

soaktuvannya

When s / c injected, the maximum anti-Xa activity (C max) is reached in 3-5 years, nadroparin is practically moistened (close to 88%). With intravenous injection, the maximum anti-Xa activity reaches less than 10 minutes, T 1/2 becomes close to 2 years.

metabolism

Metabolize mainly in the oven through desulfation and depolymerization.

vivedennya

For a subcutaneous injection of T 1/2, become close to 3.5 hours. Protect anti-Xa activity is maintained for at least 18 years of writing nadroparin in a dose of 1900 anti-Xa ME.

Pharmacokinetics in special clinical forms

Patients of the kidnapped person have experienced physiological loss of the function of nirok eliminaciya nadroparina to develop. There may be a nirkova shortage in the whole group of patients in the assessment and general formulation of the dose.

In clinical preschool children with the introduction of pharmacokinetics of nadroparin with intravenous administration to patients with nircovy deficiency of a risky step The severity of the bullet was established by the correlation between nadroparin and creatine cleansing. In case of variable values ​​of the indices in healthy volunteers, the bullet was established, but AUC and T 1/2 in patients with a minor deficiency of an easy step (CC 36-43 ml / h) bulges increased up to 52% and 39% of cases of plasma up to 63% of normal values. In patients with severe deficiency (CC 10-20 ml / h), AUC і T 1/2 bulges increased to 95% and 112%, and plasma cleansing nadroparin decreases to 50% of normal values. Patients with severe lack of severe stage (CC 3-6 ml / hv) and are on hemodialysis, AUC and T 1/2 bulges have increased up to 62% and 65% apparently, and plasma clearance of nadroparin decreases to 67% of normal values.

The results of the preliminaries showed that a small accumulation of nadroparine can be prevented in patients with mild or moderate deficiency (CC ≥ 30 ml / min.< 60 мл/мин). Следовательно, дозу Фраксипарина следует уменьшить на 25% у пациентов, получающих Фраксипарин с целью лечения тромбоэмболии, нестабильной стенокардии/инфаркта миокарда без зубца Q. Пациентам с почечной недостаточностью тяжелой степени с целью лечения данных состояний Фраксипарин противопоказан.

In patients with a nircum deficiency of a light or a middle step in the presence of Fraxiparine for the prevention of thromboembolism, the accumulation of nadroparine does not change in patients with normal function nirok, I take Fraxiparine in drug doses. If Fraxiparine is consumed with the method of prophylaxis, lowering the dose for the given category of patients is not necessary. In patients with a severe lack of severe step, who take Fraxiparin in prophylactic doses, it is necessary to reduce the dose by 25%.

Low molecular weight heparin is injected into the arterial line of the dialysis loop in high doses in order to keep the blood in the dialysis loop. Pharmacokinetic parameters fundamentally do not fluctuate, for some reason there is an overdose, if the drug can be passed into the systemic circulation before the anti-Xa factor activity, linked to the endov phase nirkova lack.

showing

- prevention of thromboembolic acceleration (in case of surgical and orthopedic complications; in patients with with a high rizik thrombosis in case of hospitalization and / or heart failure in the minds of ВІТ);

- lіkuvannya thromboembolism;

- prophylaxis of blood thinning for an hour hemodialysis;

- treatment of unstable angina and myocardial infarction without Q wave.

Prototype

- thrombocytopenia in case of nadroparin intake in anamnesis;

- signs of bleeding and alterations of rhizic bleeding, dressings with damaged hemostasis (with the blame for DIC syndrome, not caused by heparin);

— organic battle organs from the instinct to bleeding (for example, the state standard two-fingered intestines);

- injuries abo prompt engagement on head i spinal cord for in the eyes;

- internal cranial hemorrhage;

- gostry septic endocarditis;

- nirkova lack of a heavy step (CC<30 мл/мин) у пациентов, получающих Фраксипарин для лечения тромбоэмболии, нестабильной стенокардии и инфаркта миокарда без зубца Q;

- childish and adult vіk (up to 18 years);

- sensitivity is adjusted to nadroparin, or be it any other components of the drug.

Z protection Follow the sign of fraxiparin in situations that are tied with a bleeding rhizic:

- with pechinkovy deficiency;

- with nirkovy deficiency;

- with severe arterial hypertension;

- in case of peptic infestations in the anamnesis or in those who are ill with increased risk of bleeding;

- in case of impaired blood circulation in the court of the ear;

- during the operative period during operations on the brain and spinal cord, or on the eyes;

- for ailments with a weight less than 40 kg;

- in times of triviality, I recommend it (10 days);

- with a combination of drugs, which will increase the risk of bleeding.

sundown

When administered subcutaneously, the drug must be injected into the patient's position, lying down, into the subcutaneous tissue of the anterior or posterior surface of the abdomen, along the right and left side. Allowed to be inserted in the stove.

If you do not want to see the bulbs in the syringes before the injection.

The head should be inserted perpendicularly, and not down the cut, into the pinched fold of the shkiri, molded between the great and long fingers. The fold is followed by a stretch along the period of the introduction of the drug. Do not erase the missed introduction of the drug by writing.

for thromboembolism prevention in out-of-the-box surgical practice the recommended dose of Fraxiparine should be 0.3 ml (2850 anti-Xa ME) s / c. The drug should be administered 2-4 years before the operation, sometimes - 1 time / day. Likuvannya should be continued for at least 7 days, or for a period of thrombosis, until the patient is transferred to an outpatient regime.

for prevention of thromboembolism in orthopedic operations Fraxiparine should be administered subcutaneously in a dose, as it will rise in the presence of a patient's mass at 38 anti-Ha MO / kg, which can be increased to 50% on the 4th day of the operation. The pochatkova dose is prescribed 12 years before the operation, the 2nd dose - in 12 years after the operation. Dal Fraxiparine continue to use a thrombosis treatment once / until the patient is transferred to an outpatient regimen. Minimal triviality of therapy - 10 days.

Patients with a high risk of thrombosis (as a rule, they are in the middle of a resuscitation and intensive therapy) Fraxiparine is prescribed n / a 1 time / day in a dose, which will rise in the fallowness of the patient's mass. Fraxiparine should be used for thrombosis with a stretch of blood.

at unstable angina pectoris and myocardial infarction without Q wave Fraxiparin priznachayut n / a 2 times / dobu (skin 12 years). The triviality of lіkuvannya zazvychay become 6 days. In early childhood patients with unstable angina / myocardial infarction without Q wave, Fraxiparine was prescribed in combination at a dose of 325 mg / day.

The cob dose should be administered at a single dose intravenous bolus injection, the next dose should be administered n / c.

at lіkuvanny thromboembolism oral anticoagulants (if there is a contraindication) next to the sign of yakomog earlier. The therapy with FRAXIPARIN is not extended to the full value of the prothrombin hour indicator. The drug is prescribed n / a 2 times / dobu (skin 12 years), the course is trivial - 10 days. The dose is to lay in the form of a sickly mass with an anti-Ha MO / kg mass.

Prevention of blood thinning in the system of extracorporeal blood circulation during hemodialysis

The dose of Fraxiparine is guilty but was established for the skin patient individually, with the help of technical minds for the diagnosis.

Fraxiparine is administered once in the arterial line of the loop of the dialysis on the cob of the skin session. For patients without increased risk of bleeding, the recommended cob doses should be set aside from mass, but not sufficient for a 4-year-old session.

In ailments with increased risk of bleeding, it is possible to vikoristovuvati half of the recommended dose of the drug.

As soon as the session is more than 4 years old, there may be small doses of Fraxiparin.

During the further sessions of the dialogue, the dose is guilty of being taken in the fallowness of the warning effects.

A slid of spostering for the patient through the procedure of dialysis in conjunction with possible bleeding events, as well as a sign of thrombosis in the system for dialysis.

Have patients of the kidnapped vik

Have paciєntiv s nirkovy lack of light and middle degree of severity (CC ≥ 30 ml / xv i< 60 мл/мин) for (QC< 30 мл/мин) the dose should be reduced by 25%.

For lіkuvannya thromboembolism for

Pobichna diya

Undesirable reactions are presented in the abundance according to the frequency of the population: even often (> 1/10), often (> 1/100,< 1/10), иногда (>1/1000, < 1/100), редко (>1/10 000, < 1/1000), очень редко (< 1/10 000).

On the side of the blood circulation system: even more often - bleeding from localization, more often in patients with rizik factors.

On the side of the hematopoietic system: Ridko - thrombocytopenia; even more rarely - eosinophilia, reverse writing to the drug.

On the side of the hepatobiliary system: often - adjusting the activity of pechinkovy transaminases (change to a transient nature).

Three sides immune system: even more rare - reactions of increased sensitivity (nabryak Kvinke, shkirni reactions).

Miscellaneous reactions: even more often - the establishment of a small pediatric hematoma in the mіstsі іn'єкції; in some cases, the emergence of schilny vuzliks (significant encapsulation of heparin), which know through a few days; even more rarely - necrosis of the shkiri, zvychay in the introduction. The development of necrosis is triggered by the front of the purpura, or infiltrated or worse than the malignant erythematosity of the beach, which can be superficial or not superimposed on the backward symptoms (in such cases, the phraxiparine slid is inadvertently pinpointed).

Інші: even more rarely - prіapіzm, reverse hyperkalієmiya (tied to the capacity of heparins to induce the secretion of aldosterone, especially in patients from the group).

Overdose

symptoms: the main sign of overdose with subcutaneous and intravenous injection of bleeding; it is necessary to follow the number of platelets and the other parameters of the larynx of blood.

lykuvannya: insignificant bleeding is not possible for special therapy (ask for a dose to be lowered or change the dose as far as possible). I have a negative effect on the appearance of anticoagulant effects in heparin, however, in some cases, anti-Xa activity can be detected frequently. Stagnation of protamine sulfate is necessary only in important cases. A slid of vrahovuvati, about 0.6 ml of neutralizing protamine sulfate is close to 950 anti-Xa ME nadroparin. The dose of protamine sulphate is recovered in an hour, after the introduction of heparin, with a possible reduction in the dose of the antidote.

likarska vzaєmodiya

The development of hypercalculations can be found from the one-hour presence of several factors. Likuvalny preparations, How to use hypercalculations: salt calories, high blood pressure diuretics, іngіbіtori APF, Angiotensin II receptor blockers, non-steroidal anti-inflammatory drugs, heparin (low molecular weight or non-fractional), cyclosporin and tacrolimus, trimethoprim. It is not safe to develop hypercalcemia when combining high-grade foods with Fraxiparine.

Spilne zasosuvannya drug Fraxiparin with drugs that are injected into hemostasis, such as acetylsalicylic acid, Non-steroidal anti-inflammatory drugs, indirect anticoagulants, fibrinolytics and dextran, to produce the effect to the utmost strength.

In addition to that, brothers to respect, which antiaggreganti (except for acetylsalicylic acid in the form of analgesic and fever-lowering lycaria, tobto in a dose of 500 mg): abciximab, acetylsalicylic acid in antiaggregates clopidogrel, eptifibatid, iloprost, ticlopidin, tirofiban - to prevent the development of bleeding.

The drug Fraxiparin has been shown to protect patients who receive indirect anticoagulants, systemic corticosteroids and dextran. If there are indirect anticoagulants in the patients, if they take the drug fraxiparine, then it should be continued until the MHO indicator is stabilized to the required value.

special requests

I especially respect the need to come up with specific instructions from the preparation for the skin drug, which should be brought up to the class of LMWH, so that they can contain a single dose (OD abo mg). Through the inadmissibility of Fraxiparina's cherguvannya with іnshim LMG with trivial lіkuvannі. It is also necessary to respect the animals that the drug itself is victorious - Fraxiparine, or else, it’s pouring into the dosage regimen.

Graduated syringes are intended for the selection of a dose in a fallow form of a sick person.

Fraxiparine is not suitable for i / m administration.

Heparin-induced thrombocytopenia

Oscillations in case of stagnation of heparin The possibility of developing thrombocytopenia (heparin-induced thrombocytopenia) is necessary;

I had occasional problems with thrombocytopenia, which was severe, which could have been associated with arterial or venous thrombosis, but it is important to take it in the next episode:

- with thrombocytopenia;

- with a significant change in platelet counts (by 30-50% in normal values);

- in case of negative dynamics from the side of thrombosis, the drive of a patient will be eliminated;

- in case of thrombosis, a drug used for aphids;

- with disseminated intravascular coagulation syndrome.

In cich vipadkah lіkuvannya drug Fraxiparin slіd pinch.

The appointment of an immunoallergic effect is indicated between 5 and 21 days of treatment, or even earlier, if the patient has heparin-induced thrombocytopenia in history.

With the presence of heparin-induced thrombocytopenia in the anamnesis (for non-fractional or LMWH), treatment with Fraxiparine, if necessary, may be indicated. However, in this situation, strict clinical monitoring is shown, as a minimum, as well as monitoring the number of thrombocytes. When thrombocytopenia is diagnosed, the drug Fraxiparine has been safely pinched.

If thrombocytopenia is detected on aphids (non-fractionated or low molecular weight) heparins, then the possibility of anticoagulants in these groups will become apparent. If these drugs are unavailable, then it is possible to consume the LMWH. At the same time, the number of thrombocytes in the blood is spostering. As soon as the ear of thrombocytopenia progresses, it is more likely that the drug should be replaced, then later on, it should be added to the drug. It is necessary to remember that the control of platelet aggregation, scoring on in vitro tests, and its value in the diagnosis of heparin-induced thrombocytopenia is necessary.

Patients of the kidnapped vik

Before the cob is taken with Fraxiparine, it is necessary to assess the function of nirok.

hyperkalієmіya

Heparin can induce the secretion of aldosterone, which can lead to hypercalceration, especially in patients with increased concentration of calories in the blood, or in patients with a rise in blood loss in for diabet, Chronic nirk deficiency, metabolic acidosis For patients who are taking drugs that can cause hypercalculation (including Ingibitori ACE, NPZP)). Rizik hyperkaliyamії grows up with trivial therapy, or you get sick with savage therapy. In patients, who work with the group, they control the concentration of calories in the blood.

Spinal / epidural anesthesia / spinal puncture and supplemental drugs

Risks of diagnosis of spinal / epidural hematomas occur in individuals with the insertion of epidural catheters or for patients with abnormalities lykarsky zasobiv They can be inserted into hemostasis, such as non-steroidal anti-inflammatory drugs, antiaggregants and anticoagulants. Rizik, mabut, also improve when traumatic or repeated epidural spinal punctures are performed. In such a rank, nutrition about the combined stasis of neuroaxial blockade and anticoagulants is guilty of virishuvatis individually for assessing the development of cinnamon / rhizic in such situations:

- for patients who are already receiving anticoagulants, the need for mental or epidural anesthesia has been primed;

- for patients who are planning to have an effective surgical treatment due to the need for mental or epidural anesthesia, they are guilty of the need for the introduction of anti-coagulants.

When lumbar puncture is carried out for spinal / epidural anesthesia, it is guilty to undergo a minimum of 12 years before the administration of Fraxiparine with the help of prophylaxis, for 24 years with the help of treatment and the introduction of abdominal adural / spinal anesthesia. For patients with a nirkovy deficiency, an increase in the given intervals can be seen. It is necessary to be careful of the patient for signs and symptoms neurological damage... When there is a breakdown in the neurological status of a sick person, a term of appropriate therapy is required.

Salicylates, non-steroidal anti-inflammatory and antiaggreganti

With the prevention of abnormal venous thromboembolism, as well as with the prevention of laryngeal inflammation in the extracorporeal blood circulation system during hemodialysis, it is not recommended to immediately consume Fraxiparine with such drugs, including acid You can get rid of the risk of bleeding.

Inflow to the building of keruvati by transport means and mechanisms

I don’t give a gift to the drug Fraxiparine on the health of keruvati with transport means, mechanisms.

Vigor and lactation

Until the creatures did not show teratogenic or fetotoxic effects of nadroparin calcium, this is not the least, in a matter of days, if there is no dangers in it, the penetration of nadroparin calcium through the placenta in humans can take place. This drug is not recommended for Fraxiparine for vaginosity, except for vipadkiv, if there is a potential for coryza for the mother, it is not recommended for the fetus.

In the last hour, it’s not possible to see the calcium in breast milk. At the zyvazka z cyme, consuming nadroparin calcium in the period thoracic treatment not recommended.

Stuck in a childish vіtsі

Prototype indication: childish and adult vik (up to 18 years).

In case of deterioration of the functions of nirok

At the children nirkovy lack of light and peace step(CC ≥ 30 ml / xv i< 60 мл/мин) для thrombosis prevention lower dosage is not required, at patients with the lack of a difficult step(QC< 30 мл/мин) дозу следует снизить на 25%.

Have patients with easy and peaceful lack of nirk for l thromboembolism for Prevention of thromboembolism in patients with high risk of thrombosis (with unstable angina and myocardial infarction without Q wave) the dose should be reduced by 25%, for patients with severe nircovy deficiency, the drug is contraindicated.

In case of deterioration of the function of the liver

Have patients with damaged functions of the stove special dosages on the drug intake were not carried out.

Stuck in the kidnapped vice

Have patients of the kidnapped vik Corrections of doses are not required (due to the blame of patients with impaired functions of nirok). Before the cob of lіkuvannya fraccyparine it is recommended to control the indicators of the function of nirok.

Mind that term zberigannya

The drug is available for a prescription.

Mind that term zberigannya

The list of Zberigati is out of reach for children, at temperatures below 30 ° C; Don't freeze. Term of attachment - 3 rock.

Anti-Xa- a whole laboratory indicator, showing the anti-coagulant activity of LMWH (fraxiparine, clexane). It is read yak [anti-ten-a].

Low molecular weight heparin is the name of the group of drugs, which can be used to grow and grow.

showing

• I will also take away low-molecular-weight heparin to control the adequacy of treatment
• in malignant tumors with treatment with non-fractional heparin i p_vn_ sore throat in the blood, if the APHT is not indicative
• pediatric coronary bypass surgery and cardiac surgery
• thrombosis - in the course of treatment and prophylaxis - venous thrombosis of the lower symptoms,
• vaginal women with risk factors for thrombosis
• prevention of thrombosis during operations, serious illness, during reanimation visits, infections
• with hemodialis

The pre-treatment of anti-Xa will show the steps of inducing factor Xa ([ten a], Stewart-Prauer factor), the main target for heparin. In this rank, the result is bit by bit about the potential for treatment with heparin and food acceptance sufficient dose.

In a group of high-risk patients, thrombosis should be analyzed regularly for anti-Xa.

Laryngeal blood loss and bleeding - hemostasis - life important function organism. It is impossible to allow injury to lead to significant loss of blood.

To stop bleeding by the nature of the cascade of reactions, the participants who enter into the process only when the alternatives are activated. This principle allows you to quickly form a thrombus and a defect in the stage of judgment.

At the same hour, it is impossible to admit that the trivial reaction is started once, uninterruptedly, the necessary streaming factor. Tse. Vona is similar to the procoagulant, only in the direction of the thrombosis.

Coordination of the road and prototype cascade for driving along the motorway. Stamping on gas - їdemo shvidko, ale the emergency is not great, embossing on galmo - it is not unbeatable, those cars collapse with more speed and our car is impressed. Necessary balance.

That in the blood there is a presence as a factor (in an active and inactive state), as well as prototypes.

A number of hospitals and chronic ailments lead to thrombosis, or even to bleeding.

Thrombosis, tobto clogging, can practically all judges, like arteries and veins, ale nibilsh often thrombosis in the veins of the legs.

The thrombus will ruin the blood flow through the veins, and the tide will be overwhelmed. Judge to be re-raised with blood.

Two main officials of the throat - IIa і Xa (the letter "a" means active).

see heparin

• low molecular weight heparin- English abbreviation of LMWH, enter pidshkirno, deactivate the Xa factor, it is transferred, so repeated routine control is not required, it will take a trivial hour
• unfreated heparin- UFH, inject internally, block IIa factor, less than Xa, control of the dose of viscous, control the analysis on, vikoristnoy in the minds of lymph nodes for an hour (a few days), heparin can develop in the induction of thrombocytes

LMWH preparations

1. enoxaparin (clexane, anfibra, hemapaxan, enixum)
2. bemiparin (Tsibor)
3. revіparin (klivarіn)
4. nadroparin (fraxiparin, nadroparin)
5. certoparin sodium (Troparin)
6. dalteparin (fragmin)
7. fondaparіnuks (Arіkstra)

Groupy control

• patients with nirok sickness - chronic nirkova deficiency, polycystosis, chronic pyelonephritis, heparin injections from the organism,
• when taking a therapeutic (!) dose of the drug for more than 10 days
• individuals with obesity, weight tila ponad 100 kg - foldable transfer to a standard dose
• children with masoy tila less than 50 kg
• vagіtnі women - oskіlki vaga tila change
• persons up to 30 years old and 80 years old
• with a high risik accelerated

preparation

• special training before analysis is not required, unless you eat fat 6 years before the end of the day
• the analysis is done in 4-5 years after taking heparin (to stay in the drug), in this way the maximum concentration in the blood is transferred and is optimal for the X factor

norm

The rate of anti-Xa in the blood is stored as a dose of LMWH:

• prophylactic dose - 0.2 - 0.4 U / ml
• therapeutic dose - 0.5 - 1.2 U / ml

Remember, at the dermal laboratory, and more precisely at the laboratory possession of that reagents є "their" standards. Have a letterhead laboratory dosage stench go to the graph - the reference value or the norm. Tim more, that the Vovchak anticoagulant is a series of standards that are adopted.

What is pouring into the result?

• hour to receive low-molecular-weight heparin, type of drug (enoxaparin or nadroparin), dose (prophylactic or leukemia)
• function nirok

decryption

Evaluation of the result of the analysis for anti-Xa is possible only with the use of the drug heparin, which can be taken for an hour or so, or with heparin. The results of analyzes from other laboratories are uncomfortable.

The results and the analysis are between the reference values ​​(norms) Then it is possible to adjust the dose of the drug - malium risik, thrombosis, and bleeding.

Anti-Xa as a result of the analysis - an overdosage of heparin or a decrease in the rate of blood loss, an increase in the risk of bleeding.

Anti-Xa drops- the dose of heparin is not sufficient for the prevention of thrombosis.

Anti-Xa was last modified: Falling leaves 10th 2017 by Marya Bodyan

INN: Enoksaparin sodium

Virobnik: Sanofi Winthrop Industry

Anatomical-therapeutic-chemical classification: Enoxaparin

Registration number in the Republic of Kazakhstan: No. RK-LS-5 No. 012228

Restructuring period: 23.04.2018 - 23.04.2023

Instructions

Trade name

Clexan Ò

International non-patented name

Enoksaparin sodium

Lykarska form

Rozchin for ін'єкцій 2000 anti-Xa MO / 0, 2 ml, 2 single-dose syringes in front of the front with a cap system

Rozchin for ін'єкцій 4000 anti-Xa MO / 0.4 ml, 10 single-dose syringes in front of the front with a cap system

Rozchin for ін'єкцій 6000 anti-Ha MO / 0.6 ml, 2 single-dose syringes in front of the front with a cap system

Rozchin for ін'єкцій 8000 anti-Xa MO / 0.8 ml, 10 single-dose syringes in front of the front with a system

warehouse

One syringe to take revenge

active speech- enoxaparin sodium 20 mg (for a dose of 2000 anti-Xa MO / 0.2 ml), 40 mg (for a dose of 4000 anti-Xa MO / 0.4 ml), 60 mg (for a dose of 6000 anti-Xa MO / 0, 6 ml), 80 mg (for a dose of 8000 anti-Ha MO / 0.8 ml

additional speech- water for ін'єкцій.

to describe

A glimpse of razchin from a bezbarvny to a bloody color.

Pharmacotherapeutic group

Anticoagulants. Anticoagulants are direct (heparin and yoghidnі). Enoksaparin sodium.

ATC code B01AB05

Pharmacological authorities

Pharmacokinetics

Pharmacokinetic parameters of enoxaparin were evaluated on the basis of intra-hour dynamics of anti-X and anti-IIa activity in plasma at the recommended doses (validated amidolitic methods) for single-dose and repeated administration

bioavailability

When a child is introduced to enoxaparin shvidko and may get wet (close to 100%). Pikova activity in the plasma is promoted from 3 to 4 years after the introduction. Such peak activity (circulated in anti-Xa MO) becomes 0.18 ± 0.04 (for 2000 anti-Xa MO), 0.43 ± 0.11 (for 4000 anti-Xa MO) in the case of preventive therapy and 1.01 ± 0.14 (for 10,000 anti-Xa MO) during drug therapy. For intravenous bolus administration in doses of 3000 anti-Xa MO from the onset in doses of 100 anti-Xa MO / kg for 12 years, the first peak in anti-Xa factor levels is 1.16 MO / ml (n = 16), and the middle of the exhibition, accounting for 88% of the level of equally important concentration. Equally important concentration is reached on the 2nd day of therapy. At the boundaries of the recommended doses of the pharmacokinetics enoxaparin linin. Individual and interindividual variability is low. For repeated pediatric patients, 4,000 anti-Xa MO is administered 1 time to healthy volunteers who are ready to reach the next day with an average activity of enoxaparin, approximately 15% food, below the dose of a single dose. Equivalent activity of enoxaparin in the stage of enhancing good transfer from the pharmacokinetics of a single dose. For a bagatoraz pediatric injection of 100 anti-Xa MO / kg twice a day, the stage of fermentation can be reached for 3-4 days from the middle exposure, approximately 65% ​​food, less than a single dose of Xa at the maximum and minimum activity approximately 1.2 and 0.52 anti-Xa MO / ml, apparently. In the pharmacokinetics of enoxaparin sodium, it grows in the stage of development, before it is transferred, and it is located in the boundaries of the therapeutic interval. Anti-IIa activity in blood plasma after a pediatric injection is approximately 10 times lower, less anti-Xa activity. The average maximum anti-IIa activity starts to deteriorate, approximately, after 3-4 years or until the child's education and reach 0.13 anti-IIa MO / ml at reintroductions dose of 100 anti-Xa MO / kg twice for doba. In case of alcoholic reception of enoxaparin and thrombolytic drugs, the pharmacokinetic interactions did not occur.

rospodil

The anti-Xa activity of enoxaparin sodium should become approximately 5 liters and should be close to the blood supply.

metabolism

Enoxaparin sodium metabolizes, more importantly, in oven (desulfation, depolymerization).

vivedennya

The period when anti-Xa activity is observed, which helps to prevent the development of children from education, from LMWH (LMWH), less from non-fractional heparins. For enoxaparin, monophasic administration is characteristic for a period of close 4 years for a one-time pediatric dose and close to 7 years for a repeated dose. In LMWH (LMWH), the decrease in plasma activity of anti-IIa activity is higher, less anti-Xa activity. Enoxaparin and its metabolism are transported through nirki (non-destructive mechanism) and from the gut. Nirkovy clearing of fragments with anti-Xa activity to become close to 10% of the administered dose, and the initial nirkovy excretion of active and inactive components becomes 40% of the dose.

Patient group riziku

Ailment to the kidnapped vik

Oskilki nirkova function in the whole population is physiologically reduced, the result is worn out. The amount of change is not injected into the dose, or the regime is introduced during prophylactic therapy, as the nirkov function of such patients is lost in pleasant boundaries, so that if it is deprived of it, it is slightly reduced. First, don't start before LMG testing, it is important to carry out a systematic assessment of the normal function in patients older than 75 years old, stagnant Cockcroft's formula (div. " special requests» ).

Nirkova deficiency from the lung to the level of severity (tobto clearance of creatine> 30 ml / min)

In some cases, monitoring of the circulating activity of anti-Xa factor for the prevention of overdose in case of consuming enoxaparin in drug therapy (div. "Special requests").

I need to be on hemodialis

LMWH is injected into the arterial tube of the dialysis system in doses sufficient to prevent blood loss in the system.

Basically, pharmacokinetic parameters are lost without change for a vignette of overdose in case of overdose, if the drug is consumed in the extraal bloodstream, and it can lead to high anti-Xa activity, due to the lack of thermal stage.

Pharmacodynamics

Enoxaparin is a low-molecular-weight heparin, in which the antithrombotic and anticoagulant type of standard heparin is not tied between itself. It is characterized by a greater temporal anti-Xa activity, less anti-IIa or anti-thrombin activity. Spіvvіdnoshennya between two types of activity for enoxaparin to become 3.6. At prophylactic doses, do not spoil the liquid inflow on the activation of the partial thromboplastin hour (APHT). At drug doses, the APT can be increased by 1.5-2.2 times or more than the control hour at the peak of activity. Tse podovzhennya vіdobrazha surplus antithrombin dіu.

Prophylactic therapy of venous thromboembolic disease in patients who are on a post-mortem through hospitable

In a randomized subcutaneous-slavnyal dosage (MEDENOX) vaccination without baking and efficacy 2000 anti-Xa MO / 0.2 ml (20 mg / 0.2 ml) і 4000 anti-Xa MO / 0.4 ml (40 mg / 0.4 ml) enoxaparin was administered on a placebo basis to the drug during the menstrual period 1 time for an additional 6-14 days for the prevention of venous thromboembolic seizures in +1102 patients with thromboembolism. 3 days through a hospitable affliction. Among the cyclical patients at the time of 40 years of age, there was a heart failure (III or IV grade NYHA), a state of mental lack, to witness about a chronic mental deficiency, hospitality Infectious diseases for rheumatic fever, associated with a minimum of 1 rhizic factor for venous thromboembolic illness (for 75 years, cancer, a history of venous thromboembolic obesity, varicose veins veins, hormonal therapy, chronic heart failure).

At tsogo doslіdzhennya not boule vklyuchenі gospіtalіzovanі patsієnti of temple rizikom rozvitku venous tromboembolіchnih uskladnen (GOSTR іnfarkt mіokarda; zahvoryuvannya sericite, napriklad, aritmіya abo valve porazka at yakih neobhіdna terapіya of priyomom antikoagulyantіv; patsієnti of іntubatsієyu abo patsієnti, SSMSC moved іnsult in ostannі 3 mіsyatsі).

The primary end point of efficacy was the frequency of venous thromboembolic events on the 10th day (± 4) and began with the frequency of the onset of non-essential manifestations:

Glib venous thrombosis (DVT), documented confirmations for additional systematic phlebography (in 83.4% of patients with advanced disease), but with Doppler ultrasound (16.6% of patients with TB) in patients with

Symptomatic non-lethal embolism legendary artery, Pidtverdzhena for additional legacy angiography or spinal CT scan

Abo the embolism of the legendary artery with a lethal result

The value of a decrease in the frequency of venous thromboembolic events was diagnosed in 866 patients who were more mature on the 10th day (± 4), 16/291 (5.5%) in the group of receiving enoxaparin 4000 anti-Xa MO / 0.4 ml (40 mg / 0 , 4 ml) in the case of 43/288 (14.9%) in the placebo group (p = 0.0002). Ceyeffect buv in the main reasoning of significant changes in the intrinsic volume of the DVT (proximal and distal), 16/291 (5.5%) in the group with enoxaparin 4,000 IU anti-Xa / 0.4 ml (40 mg / 0.4 ml ) in the case of 41/288 (14.2%) in the placebo group (p = 0.0004). Thrombosis of glibular veins in the main asymptomatic (only 6 cases of symptomatic DVT). The clever and friendly effect is passed after 3 months.

Repeated hospitalization for treatment with enoxaparin at a dose of 4,000 MO anti-Xa / 0.4 ml (40 mg / 0.4 ml) was registered in 59% of patients.

However, if the drug is safe, then hematomas or ekhimosi> 5 cm on the site of the drug were most often spontaneous in the group when enoxaparin was taken 4,000 IU anti-Xa / 0.4 ml / day (40 mg / day), no placeb per day (40 mg / day),

In general, there were no significant indications of efficacy with enoxaparin 2000 MO anti-Xa / 0.2 ml (20 mg / 0.2 ml) and placebo.

Therapy of a gastrointestinal myocardial infarction with a segment infarctionSTin combination with thrombolytic drugs for patients, which is recommended or not recommended further through a coronary artery

In the great large-center adolescent 20,479 patients with a host of anti-myocardial infarction with ST segment infarction, in whom fibrinolytic therapy was carried out, randomized bullets for rejecting an enoxaparin from a large dose of intravenous antihypertensive -Xa / kg, with further pediatric injections at a dose of 100 anti-Xa MO / kg skin for 12 years, or non-fractionated heparin with an internal bolus dose of 60 MO / kg (maximum 4000 IU) with further non-intermittent doses of the parameter of the assets is a partial thromboplastin hour. Pidshkirne introduction of enoxaparin was carried out before the vipiska from the hospital, or for a maximum of 8 days (in 75% of cases, the minimum is 6 days). In half of the patients who were treated with heparin, the drug was administered for less than 48 years (in 89.5% of patients for 36 years or more). All patients were also treated with acetic acid for a minimum of 30 days. The dose of enoxaparin Bula was scored for patients at 75 or more years of age: 75 MO / kg for children who are 12 years old, without cob internal bolus.

In the course of a short period of time for 4716 (23%) patients, they received an anti-thrombotic therapy through a coronary artery. Patients did not take the additional dose of the drug, as the rest of the child was taken less than 8 years before the balloon was inflated; Patient trimming an internal bolus of 30 anti-Xa MO / kg, as the rest of the child was carried out more than 8 years before the balloon was inflated.

In case of stagnation of enoksaparin, a decrease in the frequency of the increase in the frequency of the primary end point was increased (a decrease in the amount of available risik by 17% (p<0,001)]. Частота рецидива инфаркта миокарда была значительно меньше в группе эноксапарина (3,4% в сравнении с 5%, p<0,001, уменьшение относительного риска на 31%). Частота летального исхода была меньше в группе эноксапарина, с отсутствием статистически значимого различия между группами терапии (6,9% в сравнении с 7,5%, p=0,11).

Spriyatlivy efekt od zastosuvannya enoksaparinu within pervinnoї kіntsevoї point CCB uzgodzhenim, Square od rozpodіlu on pіdgrupah (for vіkom, statte, lokalіzatsії іnfarktu, nayavnostі in anamnezі dіabetu abo іnfarktu mіokarda, type trombolіtichnih preparatіv that іntervalu mіzh Wink Perche klіnіchnih Find our i іnіtsіatsієyu terapії).

In case of stagnation of non-refractory heparin, the patients have demonstrated a friendly effect in patients with non-refractory heparin, for the primary efficiency in patients who underwent coronary angoplastic surgery for up to 30% of the days. also in patients who did not undergo coronary angioplastic surgery (9.7% in the case of 11.4%, 15% reduction in the amount of risk).

The frequency of massive bleeding lasting 30 days was markedly visible (p<0,0001) в группе эноксапарина (2,1%) в сравнении с группой гепарина (1,4%). Отмечалась более высокая частота желудочно-кишечного кровотечения в группе эноксапарина (0,5%) в сравнении с группой гепарина (0,1%), хотя частота внутричерепных кровотечений была схожей в обеих группах (0,8% при приеме эноксапарина в сравнении с 0,7% на фоне приема гепарина).

Analysis of warehouse criteria for the assessment of foreign clinker cories, showing statistically significant overload (p<0,0001) эноксапарина над нефракционированным гепарином: уменьшение относительного риска на 14% в пользу эноксапарина (11% в сравнении с 12.8%) для составного критерия с учетом смертности, рецидива инфаркта миокарда, или массивного кровотечения [критерии тромболиза при инфаркте миокарда (TIMI) ] в течение 30 дней, и на 17% (10,1% в сравнении с 12.2%) для составного критерия с учетом смертности, рецидива инфаркта миокарда или внутричерепного кровотечения в течение 30 дней.

Shown to sucking

Rozchin for ін'єкцій in syringes 2000 anti-Xa MO / 0.2 ml; 4000 anti-Ha MO / 0.4ml:

Prevention of venous thromboembolic disease in surgical procedures pomirny or high rizik

Prevention of blood loss in the system of extracorporeal blood circulation for an hour hemodialysis

Roschin for ін'єкцій in syringes 4000 anti-Xa MO / 0.4 ml:

Prevention of glib venous thrombosis in patients who are treated on a post-bed regime through the therapeutic concomitant hospital, including:

Sertsev lack of (III or IV class NYHA)

Gostru dyhally lack of

Epizodi of a hospitable infectious disease or a hospitable rheumatic disease in the future as a minimum with one of the factors in the development of venous thromboembolism.

ml:

Treatment of glib venous thrombosis in the presence of thromboembolism of the disease

Treatment of unstable angina and gastric myocardial infarction without Q wave in combination with acetylsalicylic acid

Treatment of a severe myocardial infarction with ST segment infarction in a combination with thrombolytic disease for patients, directly as a result of a subcutaneous percutaneous coronary artery (PCI).

How to store that dosi

Cei heparin є low molecular weight heparin.

FOR PERSONAL INJECTION (for a little bit of ailments, hemodialysis can be tolerated - for syringes, 2000 anti-Ha MO / 0.2 ml і 4000 anti-Ha MO / 0.4 ml).

FOR PEDIATRIC ADMINISTRATION (for a vignette of patients with myocardial infarction, against ST segment dislocations, when an internal bolus is required - for the range in syringes 6000 anti-Ha MO / 0.6 ml / 8000 anti) ...

Kleksan is not suitable for internal language introduction. 1 ml solution for ін'єкцій equivalent, approximately 10,000 anti-Ha MO enoxaparin.

Technics of education

Rozchin for ін'єкцій in syringes 2000 anti-Xa MO / 0.2 ml; 4000 anti-Ha MO / 0.4ml: n The syringe is ready for a safe vikorystannya, before the introduction of the injection, it is not necessary to press on the piston to see the bulbs povitrya.

Rozchin for ін'єкцій in syringes 6000 anti-Xa MO / 0.6 ml; 8000 anti-Ha MO / 0.8ml: the dose of KLEKSAN, which was introduced, went quickly until the weight of the sick one, before the introduction of the disease was observed. If there is no oversized obsyagu, the bulbs are not necessary to see before the introduction.

KleksanÒ slіd enter pіdshkіrno, bazhano, in the position of the ailing lying on the back. Ін'єкції is introduced alternately in lіva, then in the right anterolateral or posterolateral wall of the abdomen.

The entire golki should be inserted perpendicularly, and not pid kutom into the dilyanka of the shkiri, squeezed between the great fingers of the hand. During the hour of the day, the dilyanku shkiri is guilty of being squeezed between fingers.

KleksanÒ in front-facing syringes and in front-facing syringes are used only for one-time disposable suction and release through the system.

Remove the syringe from the blister pack in front of the filling, opening the pack according to the instructions on the pack. Do not pull on the plunger, the debris can be inserted into the syringe.

NOTE:

The system can be activated immediately after the introduction of the entire syringe.

The security system needs to be activated only when it is sent to the patient.

It is not possible to minify the head pack of the goalkeeper.

The sterilization system is not required.

With the activation of the safety system, there may be a small amount of growth. For optimal security during activation of the system and door-to-door.

Internal (bolus) technology. suckingClexanu 30,000 antiXaMO / 3 ml in vials for bagatoraz suctionfor the treatment of gastrointestinal myocardial infarction with ST segment disorders:

Likuvannya repair from an internal bolus, followed by which it is inaccurate to inject a child. Pochatkova dose to become

3000 MO (0.3 ml). Rozchin to the drug slid vityagti from a bottle for bagatorazovy zasosuvannya behind an additional graduated 1 ml syringe (insulin syringe). The qiu dose of enoxaparin should be injected internally. The drug can not be changed or administered at once with other drugs. In order to avoid the presence in the system of several other medicinal preparations and of the possible consumption of sodium enoxaparin, before intravenous bolus injections of CLEXAN and for the delivery of a commercial venous catheter to the layer Permanently introduced CLEXANE with 0.9% solution of sodium chloride or 5% water solution of dextrose. In the minds of the stationary, a bottle for bagatorazovy vysosuvannya at a fake vikoristovuyut for the introduction of offensive doses:

The dose required for the first pediatric injections with a size of 100 MO / kg, yak is administered one hour with internal bolus injections, while for a further pediatric injection of the drug in a skin of 100 MO / kg through

A dose of 30 IU / kg for an internal bolus injection with a further intrashortic coronary injection.

Throughout the period of testing, it is important to regularly monitor the number of thrombocytes through the development of heparin-induced thrombocytopenia (HIT) (div. "Special features of stasis").

Preventive treatment of thromboembolic clotting of veins in surgery

As a rule, there are recommendations for surgical interventions that are carried out under anesthesia. When spinal and epidural anesthesia is carried out, the coryza of the preoperative administration of the drug is reduced and theoretically we increase the risk of spinal hematomy (div. "Special features of the stasis").

Dosing regimen: 1 ін'єкція Шодня.

Dose to be administered: d RAM is installed on the premises of an individual patient, typical for a given patient and type of surgery.

Hirurgiya, which includes an internal thrombogenic rhizic

Surgery, which includes an internal thrombogenic rhizic and in patients without a high thromboembolism risk, is effective prevention to reach for the thrombosis of 2,000 anti-Xa MO (0.2 ml). Vyvcheniya mode of the introduction of transmission the introduction of the first transmission 2 years before the surgical entry.

Surgery, which includes a high thrombogenic rhizic

Surgery for stegna and colina: a dose of 4,000 anti-Xa MO (0.4 ml) is administered 1 time per dose. The introduction of the transfer mode is the introduction of the first anti-Xa MO (repeated dose) 12 years before the surgical intervention, or the introduction of the first anti-Xa MO (half dose) 2 years before the operation.

INSHI situatsії: Yakscho іsnuє pіdvischeny rizik venoznoї tromboembolії in zv'yazku type of hіrurgіchnogo vtruchannya (Especially, onkohіrurgіya) i / abo specific ailments (Especially, in nayavnіst anamnezі venoznoї tromboembolії) Mauger znadobitisya zastosuvannya profіlaktichnoї Dozy, rіvnotsіnnoї dozі, yak priznachaєtsya at ortopedichnoї surgery of a high risik, such as surgery is stegna or colina.

triviality of liking

Lіkuvannya NMG followed by the order of zі by the special methods of preparation with compression panchoches for nіg, until quiet time, leaving the ailments in the world, do not update the building until active oversupply:

In the local surgery, the triviality of the LMH's abuse is guilty for less than 10 days, as well as the typical for this sick person the rhizic venous thromboembolism (div.

The therapeutic effect of prophylactic treatment, after having sprinkled 4,000 anti-Xa MO enoxaparin in the newly introduced 4-5 times for surgical operation on the stegna

As far as venous thromboembolism is concerned, it is not safe to use the recommended triviality of treatment, it may be necessary to continue prophylactic therapy, zokrem, for the additional indication of oral anticoagulants.

Protest, the clinical effect of trivial LMWH treatment with oral anticoagulants has not yet been evaluated.

Preventive treatment in medicalinstall

The dose is indicated: a dose of 40 mg, tobto 4,000 anti-Xa MO / 0.4 ml, is administered 1 time on a supplementary route of a child's education.

The triviality of therapy: the bulo is brought up, so that additional help is needed before the period between 6 and 14 in the afternoon. At the present moment, it is not known in terms of efficiency and safety of preventive therapy, which can be carried out for more than 14 days. Also, risk of venous thromboembolism will be taken care of, followed by continued prophylactic therapy, with orally administered anticoagulants.

Prevention of laryngeal disease in the system of extracorporeal blood circulation / hemodialysis

Intravascular way of storing(Into the arterial line of the dialogue channel). Prevention of coagulation in the extrarenal cleansing system and ailments, so that you have to undergo repeated hemodialysis sessions, reach for the injection of a cob dose of 100 anti-Xa MO / kg into the arterial line of the dialysis channel on the cob. The dose, which is administered at a single intravascular bolus, is only available for hemodynamic procedures for 4 years or less. The dose can be scored with a high degree of individual and interindividual variability. The maximum recommended dose is 100 anti-Xa MO / kg. For an hour hemodialysis of ailments with a high risk of development of bleeding (sprouting, preoperative and hypooperative dialis), for with active bleeding, the procedure can be carried out from a patient dose of 50 anti-Xa MO / kg (up to 75 (one access to the Sudin).

Treatment of glib venous thrombosis (DVT), in the presence of thromboembolism of the legacy artery, or without it, but without important clinical symptoms

If there is a suspicion on DVT, the diagnosis is quickly confirmed, having carried out the confirmation.

Dosing regimen: two ін'єкції per day with a 12-year interval.

dose: for one ін'єкції to become 100 anti-Xa MO / kg. Dose LMW when weighing 100 kg or less than 40 kg was not evaluated. The efficiency of LMWH treatment can often be reduced in patients over 100 kg, and the risk of bleeding can be reduced in patients under 40 kg. For such ailments it is necessary to carry out special clinical monitoring.

The triviality of patients with DVT: Likuvannya of LMWH later quickly replaces injections with oral anticoagulants, although there is no contraindication. The triviality of LMG drinking is not to blame for 10 days, including the hour necessary for reaching the necessary oral anticoagulant effect, for a vignette of vipadkiv, if you achieve this important (div. "Specialties"). It will then be easier for you to begin oral anticoagulant therapy.

Treatment of unstable angina / myocardial infarction without Q wave

A dose of 100 anti-Xa MO / kg enoxaparin is administered by a pediatric route two times per 12-year interval in combination with acetylsalicylic acid (recommended dose: 75-325 mg orally, by mouth) It is recommended that the triviality of the therapy should be made close to 2-8 days, until quiet times, as long as there is no more stable clinical camp of the sick person.

Treatment of a severe myocardial infarction with ST segment infarction in a combination with a thrombolytic disease for ailments, directly as a result of an underlying percutaneous coronary artery disease

As a follow-up to the cob internal bolus injection 3000 anti-Xa MO, inject 100 MO anti-Xa / kg in between 15 quilins, at least 12 years for the skin (for the first 2 doses of 10 anti-Xa doses, maximum

The first dose of enoxaparin should be injected at any hour in the period for 15 minutes to 30 minutes for an ear of thrombolytic therapy (fibrin specific). It is recommended that the triviality of therapy be set for 8 days, or until a quiet feast, as long as the sick person is not sent to the hospital, as the hospitalization is less than 8 days.

Patient therapy: if I show symptoms, it is more likely to blame for the use of acetylsalicylic acid, and an additional dose is responsible for 75-325 mg per day for at least 30 days, as it is not indicated for injection.

Patients with transient coronary entrances:

Even at the moment of the end of the child's education it took less than 8 years for the balloon to pump up the balloon, it was not necessary

Even at the moment of the end of the child's life it took more than 8 years to inflate the balloon, an internal bolus of 30 anti-Xa MO / kg enoxaparin is required. For the safety of the accuracy of the treatment, which is necessary for the administration, the drug is recommended to be raised to 300 IU / ml (tobto 0.3 ml of enoxaparin, diluted in 10 ml) (div. Table below).

Obligations for ін'єкції, if divorce is good for sick people with coronary arrears:

Patients who are 75 years old and older: To be located on the drive of a severe myocardial infarction with ST segment infarction, do not enter a cob internal bolus. Skin 12 years old, inject a dose of 75 anti-Xa MO / kg (only for the first two, maximum 7500 anti-Xa MO).

Pobichna diya

Hemorrhagic symptoms, associated in the main with the apparent lack of supportive factors in the disease: organic deterioration, because of the tendency to bleeding and deyakіkі kіkіkі kombіnatsії (div. hemorrhagic symptoms, related to inadequate therapeutic recommendations, especially, triviality of treatment and correction of doses on the basis of masi tila (div. "Special features of stasis").

Hematoma, possible with pediatric introduction in the hospital. Rizik formulated such hematomas to develop in the event of unsuccessful recommendations from the technology, the introduction of any unsupported material for inappropriate material. Solid universities, who know for a long time, can develop as a result of a fiery reaction and in the process of therapy.

Thrombocytopenia 2 types:

Type I - the most frequent, sweetheart, be of an amicable character (> 100,000 / mm 3), winery in the early stages (up to 5 days)

Type II - is a very important immunoallergic thrombocytopenia (HIT). The frequency of this manifestation is weakly vivified (div. "Osobennosti zasosuvannya").

Increased platelet counts asymptomatic and werewolves

Osteoporosis, risik development cannot be eliminated in case of more trivial lycuvanne, as in case of non-fractionated heparin

Timchasove

ridko

Spinal hematoma after the introduction of LMWH for an hour of spinal anesthesia, anesthesia or epidural anesthesia. These reactions led to the development of the nervous system and the risky level of gravity, including trivial or permanent parallich (div. "The specialties of stagnation").

Necrosis of the shkiri, most often in the world of іn'єktsії, which can overwhelm the belt of purple or infiltrated, sickly erythematous beaches. In such cases, it is inaccurate to pin the therapy.

Shkirni abo systemic allergic reactions, which lead in deyaky vipadkakh until kasuvannya lykuvannya

Duzhe Ridko

Vasculitis through the advancement of school sensitivity

Hypereosinophilia, which can be trapped in isolated vapors, or spilloverly with school reactions, and is allowed in the event of an illness.

In okremikh vipadkah

hyperkalієmіya

Prototype

Regardless of the dosage (therapeutic or prophylactic), the whole drug is not used in offensive situations:

Hypersensitivity to enoxaparin, heparin, and other children, including LMWH

Evidence in the anamnesis of severe, heparin-induced thrombocytopenia (HIT) type II, viclican non-fractional or low molecular weight heparin (div.

Bleeding, or coughness to bleeding, is associated with impaired hemostasis (for those who are ill, there may be a syndrome of deseminated intravascular laryngeal disease, which is not associated with tying with heparin.

Organizational damage from strength to bleeding

Clinically significant active bleeding

- Clexane30,000 antiXaMO / 3 ml: Daniy the drug has contraindications for children up to 3 years in combination with benzyl alcohol.

At a therapeutic dose, the drug is not used in offensive situations:

intramuscular bleeding

Severe nirkov lack, in connection with the appearance of the given data (the value of creatine at the end of the day is close to 30 ml / hv when evaluating the Cockcroft formula), due to some vignettes of vintages. Patients with severe nircovy lack of success in taking unfractionated heparin. For an accurate description of Cockcroft's formula, it is necessary to vikoristovuvati the data of the last vimiryuvannya masi tila (div.

Spinal or epidural anesthesia should not be performed in patients who are treated with LMWH.

At therapeutic doses, the whole drug is not recommended in general in offensive situations:

Gostry the great ischemic insult, with or without the destruction of svidomosty. As soon as it is an insult to an embolism, it is not possible to store an enoxaparin in the first 72 years of this date. The efficiency of LMWH drug doses has not yet been established, regardless of the reason, the widening or the severity of clinical manifestations of cerebral infarction.

Gostriy infectious endocarditis

Nirkova lack of a lung to a level of severity (creatine clearance more than 30 and less than 60 ml / h)

One-hour reception with advanced drugs (div. "Likarski vzaєmodii"):

Refinery (systemic storage)

At prophylactic doses, the drug is generally not recommended in the offensive situations:

An important nirkova deficiency (creatine clearance is close to 30 ml / min when evaluating Cockcroft's formula (div. "Particularities of consumption")

In the first 24 years of age for internal cerebral hemorrhage

For patients with a kidney disease who are older than 65 years of age with an one-hour reception with advance drugs (div. "Likarski vzaєmodia"):

Acetylsalicilic acid in antipyretic, antipyretic and antihepatic doses

Refinery (systemic storage)

Dextran 40 (parenteral administration)

likarskі vzaєmodії

Deyakі lіkarskі preparations mozhut viklikati yavischa gіperkalієmії, napriklad, solі kalіyu, kalіyzberіgayuchі dіuretiki, іngіbіtori ACE (enzyme іngіbіtori angіotenzinperetvoryuyuchogo) antagonіsti angіotenzinu receptor II, nesteroїdnі protizapalnі lіkarskі drugs, heparin (nizkomolekulyarny abo nefraktsіonovany), cyclosporine, takrolіmus i trimethoprim.

The development of hypercalculation can be found among the young, connected with it factors in the risk. Rizik giperkalієmii grows, if vischevkazanі lіkarski zoobi zastosovovyuschaya one hour.

For patients who are less than 65 years old with drug doses of LMWH and for patients with a sickly age (over 65 years old), just as a dose of LMWH

Acetylsalicylic acid in anti-inflammatory, antipyretic and antiapaline doses (according to extrapolation and salicylate): an increase in the risk of hemorrhage (due to salicylates in the treatment of thrombocyte mucosa and intestinal lesions) Slіd zastosovuvati zazoznіzhuvalnu zsіboluyuyu zіb, scho does not go to salicylates (for example, paracetamol).

Non-steroidal anti-inflammatory diseases (systemic stagnation): an increase in the risk of bleeding (the refinery has adjusted the function of platelets and the reduction of the mucous membrane of the intestinal tract). As soon as one hour, it is inevitable that retail monitoring is required.

Dextran 40 (parenteral administration): an increase in the risk of bleeding (due to the function of platelets with dextrans 40).

Combinations, how to make sure that you enter the safety

Oral anticoagulant: strengthening the anticoagulant effect. When replacing heparin with an oral anticoagulant, clinical monitoring is necessary.

Combinations, like a step to take to respect

Іngіbіtori agregatsії trombotsitіv (INSHI, nіzh atsetilsalіtsilova acid znebolyuyuchoyu, zharoznizhuvalnu i protizapalnu doses): abciximab, antiplatelet atsetilsalіtsilova acid at doses that kardіologіchnih nevrologіchnih indications, beraprost, klopіdogrel, eptifіbatid, іloprost, tiklopіdin, tirofiban: pіdvischeny rizik krovotechі.

Patients under 65 years old on prophylactic doses of LMWH

combination, Yakі slіd take to uvaga

Combination of stasis of lykarsky zasobiv, which is injected into the stage for hemostasis, increases the risk of bleeding. Otzhe, Square od vіku patsієnta, slіd provoditi bezperervny klіnіchny monіtoring i at neobhіdnostі, laboratory testіv, if priznachayutsya profіlaktichnі Dozy LMWH odnochasno of oral anticoagulants, іngіbіtorami agregatsії trombotsitіv (abciximab, nesteroїdnі protizapalnі zasobi, atsetilsalіtsilova acid to whether yakіy dozі, klopіdogrel, eptifibatid, iloprost, ticlopidin, tirofoban) and thrombolytic substances.

special requests

Forward and outwardly come in

Unimportant to those who concentrate the new LMWHs in the international units of anti-Xa (MO), their effectiveness is not produced only until the anti-Xa activity. It may be a good substitute for one LMWH dosage regimen for the LMWH dosage regimen, or for the LMH dosage regimen for a drug based on the other synthetic polysaccharide in conjunction with them, as well as the development of the LMWH dosage regimen. In such a rank, it is recommended to recommend an individualized approach and the application of specific instructions for storing a skin drug.

Clexane30,000 antiXaMO / 3 ml: Cei lykarsky drug revenge 15 mg / ml benzyl alcohol. The drug can be toxic and anaphylactic reaction in newborns and children in up to 3 years.

special improvement

risik bleeding

It is necessary to take the recommended dosage modes (dosage and triviality of treatment). Failure to catch up on these recommendations can lead to the development of bleeding, sprouting, in patients of a group who have been affected by a rizik (for example, a patient of a kidnapped person, a patient for a lack of nirkov).

Vip drops of important bleeding boules are registered in such situations:

Patients of the kidnapped vik, zokrem, as a result of the vikoval decrease in the function of nirok

Ailment with nirk deficiency

Masa tila lower 40 kg

Suddenly the drug was consumed to increase the risk of bleeding (div. "Lykarski vzaєmodii").

In all cases, it is important to carry out special monitoring for those who are ill with a kidney disease and / or those who are ill with a nircovy deficiency, as well as for cases of more than 10 days.

In some cases, there may be significant anti-Xa activity for the accumulation of the drug (div. "Zasterezhennya").

Rizik development of heparin-induced thrombocytopenia (HIT)

With the development of onset thrombotic acceleration in ailments, who are treated with LMWH (drug or prophylactic dose):

Thrombosis aggravated by lykuvannya

Embolism of the Legendary Artery

Gostra ischemia of lower kintsivok

For navit myocardial infarction or ischemic stroke

if the development of the GIT is allowed to start, the number of thrombocytes is increased in the term by the number of platelets.

Stagnation in pediatrics

It is not recommended to use LMWH in pediatric practice in connection with the attendance of the given tributes.

Mechanical prosthetic heart valves

Stasis of enoxaparin for the prevention of thromboembolic acceleration in patients with mechanical prosthetic valves was not specially implanted in the heart. Protectively, there was a history of thrombosis in patients with mechanical prosthetic valves of the heart, who were treated with enoxaparin for the prevention of thromboembolic accelerations.

Zasosuvannya at vagіtny women

In the case of critical women, for the participation of vaginal women with a mechanical prosthetic valve of the heart, they were treated with 100 anti-Xa MO / kg enoxaparin two times in order to reduce the risk of developing thromboembolic thrombus death of mother and fetus. Also, in the course of post-marketing caution, there was a diagnosis of valve thrombosis in vaginal women with mechanical prosthetic heart valves, when enoxaparin was trimmed for the prevention of thromboembolic pain. In such a rank, the development of thromboembolic accelerators for a whole group of patients can be found.

medical prophylaxis

Even the presence of an episode of a severe infectious or rheumatic illness, a prophylactic treatment is probably not in that case, if I want one of the onset factors in the risk of venous thromboembolism:

Вік older than 75 rockіv

cancer

History of venous thromboembolism

obesity

hormonal therapy

Sertseva lack

Chronic dichal deficiency

Є deprivation of admission to the consumption of a drug for prophylaxis in patients over 80 years old with a weight less than 40 kg.

Zapobizhnі come in

bleeding

Also, as a result of anticoagulants, there is a lot of development of bleeding (div. Rozdil "Pobichni diy"). In the development of bleeding, there is a reason for the development of the bleeding.

function nirok

First of all, to start thinking about NMH, it is important to assess the function of nirok, zokrem, in sick people of the 75-year-old age and older, they use a creatine clearence according to Cockcroft's formula on the basis of the recent change of vagi til:

For cholovikiv, CC = (140-vik) x wag / (0.814 x creatine in blood plasma), deviation in rocks, wag - in kg, and creatine in blood plasma - in μmol / l.

For women, the formula is fast-paced, the result is multiplied by 0.85. Even the creatinine of the blood plasma beats in mg / ml, the indicator should be multiplied by 8.8.

In patients with diagnoses of important nirkova deficiencies (CC is close to 30 ml / h), the intake of LMWH in drug therapy is not shown (div. "Prototype").

laboratory analyzes

Monitoring of platelet counts in patients who are treated with LMWH and heparin-induced thrombocytopenia (tobto HITIItype):

LMWH can suffer from type II HIT, the importance of immuno-mediated thrombocytopenia, which can lead to the development of arterial or venous thromboembolism, as it can be life-threatening, or put on a functional prognosis (divine). For optimal detection of HIT, follow the patients in the following way:

- surgical intervention or a recent injury (lasting 3 months):

Regardless of the type of therapy indicated - it is either prophylactic or therapeutic, it is necessary to systematically conduct laboratory analyzes for all patients, since the rate of development of HIT is> 0.1%, or> 1% during operations and injuries. Within the framework of this analysis, the number of platelets is estimated:

Until the LMH is used, for a minimum of 24 years to get a cob of therapy

Consume 2 times a day for 1 month (maximum period)

Then, if the therapy is trivial, once a day until the therapy is applied

- drops, except for surgical involvement or recently suffered injuries (lasting 3 months):

Independently of the type of designated therapy - it is either prophylactic or therapeutic, it is necessary to systematically conduct laboratory analyzes for the same reasons, as well as in surgery and traumatology (div. Description of the disease) in patients:

Earlier, non-fractionated heparin (UFH) was eliminated, for LMWH in the last 6 months, in addition, the frequency of HIT is> 0.1%, or> 1%

The obvious fellow sickness, With the urahuvannyam of the potential degree of severity of HIT in cich patients.

In the largest drops of the lowest frequency of the GIT (<0,1%), контроль числа тромбоцитов может быть снижен до:

The number of thrombocytes per ear of therapy, or over 24 years of therapy

The number of thrombocytes in the presence of clinical symptoms with adolescence on HIT (be it a new episode of arterial and / or venous thromboembolism, as a painful disorder of the child in the therapy of such an illness, be it any new episode of arterial thromboembolism) Patients who are at fault have been informed about the possibility of such symptoms and about the need for some reason, about the symptoms of a drug.

It is possible to estimate the appearance of HIT, if the number of platelets is lower than 150,000 / mm 3 or 150 gig / l) or, if the number of platelets is reduced by 30-50% for the results of the last 2 recent measurements of the number of platelets. HIT generally develops on days 5-21 after heparin therapy (with maximum speed in about 10 days). The process of acceleration can develop significantly earlier in patients with a history of HIT; In some cases, such phenomena were spontaneous after the end of 21 days. For patients with such anamnesis, it is necessary to carry out systematic caution and retreat until the ear of therapy. In all cases, the manifestation of HIT is the same situation, when it is necessary to use an inexpensive therapy and thought of a problem. Significance of a decrease in the number of platelets (30-50% in some cases) є by a pre-juvenile signal to navigate before reaching the critical level. With a change in the number of thrombocytes, in all cases, the following procedures are guilty:

1) the inaccuracy of the number of thrombocytes with the help of confirmation of diagnosis

2) treatment with heparin, if the change in the number of platelets is confirmed, or judging from the results of the analysis, if there are any obvious reasons. Slide blood samples into test tubes with citrate for testing tests in vitro on aggregation of platelets and immunological tests. However, in such cases of unauthorized visits, it was not accepted on the test in vitro on the aggregation of platelets or immunological tests in conjunction with them, so that the test can be done without any special laboratory tests, and the results are available in a few years. However, it is necessary to carry out all the tests for diagnostics as soon as possible, as in the case of advanced therapy with heparin, a high risk of thrombosis develops.

3) prophylaxis of abnormal treatment of thrombotic acceleration, tying from HIT. Even though the continued therapy with anticoagulants seems to be important, heparin should be replaced by an antithrombotic drug from the group, for example, sodium danaproid or lepirudin, which is recognized in drug doses as well as prophylactic. Replacement with oral anticoagulants is possible only for normalization of the number of platelets through the risk of recurrent thrombosis due to the injection of oral anticoagulants.

Replacing heparin with oral anticoagulants

As a result, it is critical to be careful and to carry out laboratory tests [prothrombin hour, as it turns out to be internationally normalized reporting (MNO)] for the prevention of oral anticoagulants. At the connection with an obvious interval, before the development of the maximum effect of an oral anticoagulant, heparin therapy should be carried out in a continuous dose for an hour, which would be necessary for the improvement of INR in the last test range.

Anti-factor monitoringXa-activity

In connection with the time, there are a large number of clinical reports, in some cases, the effectiveness of LMWH was demonstrated, and the effectiveness of the LMWH was demonstrated, but it was carried out from the reception of the dose, which was rooted on the presentation of the mass without specific laboratory monitoring, and inadequacy for testing. However, laboratory tests, for example, for the monitoring of anti-Xa activity, can be found to be crimson for managing the risk of bleeding in case of some kind of key masses, often supervising an overdose.

At the zv'yazuvany doses, such vipoduyutsya, the head rank, lіkuvalny indication of LMWH for consuming ailments:

Nirkovyu deficiency from the lung to the level of the level (clearance of creatine is approximately from 30 ml / min to 60 ml / min, insurance from Cocroft's formula). At the same time, it is important that LMWH must be introduced through nirks, on the form of a standard non-fractional heparin, whether a nirk deficiency can lead to an obvious overdose. Severe nirkov lack of є contraindications for the consumption of LMWH in drug doses (div. "Prototype indication")

S superbly great, for low masoyu tila

With bleeding undesirable etiology

For the development of a potential accumulation of heparin during the reintroduction, it is recommended, if necessary, shelter for analysis at the peak of activity (as of now), so that, after about 4 years, after the third drug is administered, two doba. Repeated analyzes of anti-Xa activity to determine the level of heparin in the blood, which should be carried out, for example, on the skin 2-3 days, should be recognized in an individual order in the occurrence of the results of the foregoing analysis, with a certain amount of appearance. Visible anti-Xa activity is varied for cutaneous LMWH and cutaneous dosage regimen.

Before the visit: at the present time, the average indicator (± standard display), after 4 years after the 7th inn'єktsii enoxaparin, should be administered at a dose of 100 anti-Xa MO / kg / two times becoming 1.20 ± 0.17 anti-Xa MO / ml.

The same average indicator was promoted in clinical studies by the anti-Xa activity of the anti-Xa activity by the chromogenic (amidolitic) method.

Activation of partial thromboplastin hour (APHT)

Deyaki NMG wiklikayut about the increase of the APTCH. Oscillations of key importance are not brought, there is no need for a test for monitoring the test.

Spinal / epidural anesthesia in patients with prophylactic

lіkuvanni NMG

As well as in the case of other anticoagulants, with one-hour signs of low-molecular-weight heparins, only one type of spinal hematoma was diagnosed for an hour after an hour of mental or epidural anesthesia, and paralysis of the post-mortem. Rizik development of spinal hematoma in the form of epidural anesthesia, carried out behind the aid of a catheter, less in the form of spinal anesthesia. Rizik of minor children may develop in the development of a trivial stasis of epidural catheters in the period of operative operation. If it is necessary to preoperatively treat LMWH (ailments, such as a trivial hour before a lid, an injury), and also a coryza from a muscular / regional spinal anesthesia is very important for a patient to recover from Heparin and spinal anesthesia passed at least 12 years. It is recommended to conduct retinal neurological monitoring through the spinal hematoma. Prophylactic treatment of LMWH can be repaired in 6-8 years after anesthesia, or a visible catheter, without neurological monitoring. It is necessary to take special care when injected with the drug one hour with other drugs, which is infused into hemostasis (especially, non-steroidal anti-epileptic drugs, acetylsalicylic acid).

Situations tied with a special rizik

Monitoring of the progress of the ability in offensive situations:

pechinkova lack

Shlunkovo-intestinal malformations in anamnesis or any organ changes, severe to bleeding

Sudinne fall ill with horiretini

Period of surgery during surgery on the brain or spinal cord

Lumbar puncture: a trace of intraspinal hemorrhage and, if possible, is put forward for the next period

Immediately zasosuvannya lykarsky zasobіv, scho inject on hemostasis (div. "Lykarski vzaєmodii")

Percutaneous coronary revascularization (PCR) procedures (for KLEKSANU 6,000, 8,000, 10,000 and 30,000 anti-XaMO)

In order to reduce the risk of bleeding due to transverse coronary involvement during therapy of unstable angina pectoris, myocardial infarction without Q wave, and myocardial infarction due to ST segment pyomyoma, it was recommended to strictly take the recommended dosage. It is important to achieve hemostasis in the puncture point of the CHKR. In case of a zastosuvannya zahisny attachment, the catheter can be secured viveniyu. Once the method of manual compression is used, the catheter is guilty of being introduced in 6 years after the last child / internal injection of sodium enoxaparin. As the therapy is trivial, the onset dosage regimen is to blame for the signs not earlier than 6-8 years after the catheter is visible. Slid assessment of the appearance of signs of bleeding or the formation of hematoma in the insertion of the catheter.

availability

In the reported prerequisites for any facts, the teratogenicity of enoxaparin has not been shown. When there is a teratogenic effect in pre-clinical studies, an analogous effect when a drug is consumed in clinical studies cannot be detected. On the current day, in the retrospectively planned preliminaries on two types of creatures, it was shown that the speech viklikayut vices of development in humans, and also exhibit a teratogenic effect in creatures.

First trimester prophylactic therapy and clinical therapy

On the new year's day, there is a clinical lack of evidence for the assessment of the potent teratogenic and fetotoxic effects of enoxaparin, which should be indicated as a prophylactic method during the first trimester of vaginosity in any case. Otzhe, in the absence of enoxaparin approach, it is not recommended to sign it for preventive purposes during the first trimester or in drug doses throughout all vaginosity. Epidural anesthesia and prophylactic treatment with heparin should be planned for at least 12 years prior to anesthesia. Epidural or spinal anesthesia is not guilty of nicholas and is carried out with LMWH administration.

Preventive treatment during the 2nd and 3rd trimesters

At the present day of the clinical consumption of enoxaparin, in a small number of vaginities in the 2nd and 3rd trimesters, it is not possible to refer to those that are indicated in profilactic doses. However, it is necessary to provide additional information for assessing the effects in the cikh countries.

Otzhe, prophylaxis with enoxaparin every hour of the 2nd and 3rd trimesters can be carried out at times of consumption. Epidural anesthesia and prophylactic treatment with heparin should be planned for at least 12 years prior to anesthesia.

lactation

So, as gastrointestinal absorption in newborns maloimovirna, women who are breastfeeding, treatment with enoxaparin is not contraindicated.

Special features in pouring likarsky into the building of keruvati by means of transport or potentially not safe mechanisms

Not installed.

Overdose

symptoms: hemorrhagic acceleration in case of severe overdose in case of pediatric administration of massive doses of LMWH. In case of development of bleeding in children, it is possible to carry out treatment with protamine sulfate from the following factors:

The effectiveness of the drug on the basis of the amount of lower, lower efficiency, is registered in case of an overdose of unfractionated heparin

Through unremarkable reactions (especially anaphylactic shock), it is followed until the drug is prescribed to treat cinnamon / rhizic protamine sulfate. Neutralization of KLEKSAN is carried out by way of general internal introduction of protamine (in viglyadi sulfate or hydrochloride).

A dose of protamine is required to be stored in:

Introduced dose of heparin (100 anti-heparin unit of protamine neutralizing activity 100 anti-Xa MO LMWH), as well as the introduction of sodium enoxaparin during the last 8 years

By the hour, when the heparin was injected:

It is possible to administer infusion with a dose of 50 anti-heparin unit protamine per 100 anti-Xa MO enoxaparin sodium, if at the time of administration of sodium enoxaparin it has passed more than 8 years, if a different dose of protamine is needed

The need for the introduced protamin is nem, as at the moment of the onsite enoxaparin more than 12 years have passed.

Protest, I will hardly increase the neutralization of anti-Xa activity. In addition, neutralization can be less time-consuming through the pharmacokinetic peculiarities of the LMWH, or you can squeeze a subordinate calculated dose of protamine on the decal in the period of 24 years.

In general, do not get clean serious heritage If the received LMWH is taken in large quantities (not registered vipads) through the arch of the low soaked drug into the drain and the intestine.

Form vipusku i packaging

0.2 ml or 0.6 ml in the syringes with the golk capture system. Place 2 syringes in front of the front into a plastic container. 1 container at a time with instructions for medical storage by sovereign and Russian movs to put into a cardboard box.

3832

Anti-Xa - tse

laboratory indicator showing the anti-coagulation activity of LMWH.

low molecular weight heparin - the name of the group of drugs, which build up shelter, shy, more fluid, kind.

Shown before the endorsement of NMH:

• heart disease - gostry myocardial infarction, unstable angina pectoris, gostry coronary syndrome
• for pediatric coronary bypass surgery and other cardiological operations
• thrombosis - in the course of treatment and prophylaxis - venous thrombosis of the lower symptoms, thromboembolism of the leg artery, thrombosis of the cavernous sinus, Budd-Kyar syndrome, thrombosis of the portal vein
• vaginal women with risk factors for thrombosis
• prevention of thrombosis during operations, serious illness, during reanimation visits, infections
• with hemodialis

Doslіdzhennya anti-Xa allow assessment on the scores of attribution Xa factor of throat throat (Stuart-Prower factor) , Head meta heparin. Thus, the result of the analysis, by and large, is indicative of the increase in the rate of treatment with heparin and the increase in the nutritional intake of a sufficient dose. In groups of high rhizik thrombosis, anti-Xa analyzes are carried out regularly.

Blood loss and bleeding - hemostasis - life is important to the function of the body. It is impossible to allow injury to lead to significant loss of blood. Therefore, for the sake of bleeding by nature, there is a cascade of reactions, the participants who enter into the process only when activating the alternatives. This principle allows you to quickly form a thrombus and a defect in the stage of judgment. Ale, it is impossible to admit, that the reaction of the trivial is launched once, uninterruptedly, the necessary streaming factor. Їx is called the anticoagulant system. Vona is analogous to the procoagulant one, only the anti-thrombosis process is localized to the process of thrombosis.

Coordination of the robotics and prototype cascades of the road by car on the highway. Stamping on the gas - їdemo shvidko, ale the accident is great, embossing on the galmo - it’s also not safe, some of our cars go with great speed and our car is at the factory. Balance needs to be adjusted. To that in the blood there is a presence as a factor (in an active and inactive state), as well as prototypes, which give blood the ability to flow freely through the vessels.

A number of hospitals and chronic ailments should be produced before they get sheltered or even shyly get sick - thrombosis, or if they don't get caught up - in such a way there are bleeding.

Thrombosis, tobto clogging, can practically be all judges, like arteries and veins, ale most often thrombosis thrombosis in the veins of the lower cults. A thrombus pereshkodzhaє vіlny blood flow, the flood is overwhelmed by a large іvnі, ale to the current - dumb. Judge to be rewarded with blood, which is susidniy fabrics.

A part of a blood clot can go up and down the riverbed. Oscillations of all veins converge in the right part of the heart, yak vede to the lungs, a thrombus from the veins of the leg can occur thrombosis of the leg artery (yak, according to the essence, є vein, as it has no venous roof). Before a blood clot can be consumed in the heart and myocardial infarction. In vaginal women, a blood clot can clog up the vessel, leading to the fetus and leading to its bend.

Heparin inactive two main officials of the throat - IIa and Xa (the letter "a" means active).

There are two main types of heparin:

• low molecular weight heparin - English abbreviation LMWH, it is introduced in a pedagogical way, deactivating the X factor, it is transferred, so repeated routine control is not required, it can be trivial
• unfreated heparin - UFH, administered intravenously, blocking factor IIa, less than Xa, control of the dose of viscous extra blood clotting, staying in hospitalized patients with blood clots for an hour, may develop low blood clots

LMWH preparations:

1. enoxaparin (clexane, anfibra, hemapaxan, enixum)
2. bemiparin (Tsibor)
3. revіparin (klivarіn)
4. nadroparin calcium (fraxiparin, nadroparin)
5. certoparin sodium (Troparin)
6. dalteparin (fragmin)
7. fondaparіnuks (Arіkstra)

Analysis for anti-Xa is indicated:

• I will also take away low-molecular-weight heparin to control the adequacy of treatment
• in rare cases in case of lyuvanne non-fractional heparin and caused by factor VIII hypotharynia in the blood, while the APHT has few impressions

Groupy control anti-Xa:

• paciєnti from nirok - Chronic nirkova deficiency, polycystosis, chronic glomerulonephritis, chronic pyelonephritis, heparin from the organism is introduced into the organism, as a result of which
• when taking a therapeutic (!) dose of the drug for more than 10 days
• individuals with obesity, weight tila ponad 100 kg - foldable transfer to a standard dose
• children with masoy tila less than 50 kg
• vagіtnі women - oskіlki vaga tila change
• persons up to 30 years old and 80 years old
• with a high risik accelerated

preparation

• special training before analysis is not required, unless you eat fat 6 years before the end of the day
• the analysis is done in 4-5 years after taking heparin (to stay in the drug), in this way the maximum concentration in the blood is transferred and is optimal for the X factor

Anti-Xa rate in blood

Nemaє anti-Xa universal norms in blood. The laboratory, how to carry out the follow-up, can take the reference lines for the skin preparation and the dose - it is drug-like or prophylactic.

How is it infused into the result of the analysis?

• hour to receive low-molecular-weight heparin, type of drug (enoxaparin or nadroparin), dose (prophylactic or leukemia)
• function nirok

Decoding the result of the analysis for anti-Xa

otsinuvati anti-Xa analysis results It is possible only with urahuvannyam drug heparin, an hour and a kind of sickness, like heparin likuyut. The results of the analyzes from the old laboratories are uncomfortably torn;

yaksho the results of the analysis are located between the reference values (Norm), then it is possible to adjust the dose of the drug - malium risik, thrombosis, and bleeding.

Anti-Xa indicator as a result of the analysis - an overdose of heparin, or a decrease in the rate of blood loss, an increase in the risk of bleeding.

Decreases in anti-Xa indicator - the dose of heparin is not enough to improve the development of thrombosis, due to the development of the disease.

Warehouse i form vipusku

in blister 2 disposable syringes, 0.3 ml each; in a box of cardboard 1 or 5 blisters.

in blister 2 disposable syringes, 0.4 ml each; in a box of cardboard 1 or 5 blisters.

in blister 2 disposable syringes, 0.6 ml each; in a box of cardboard 1 or 5 blisters.

in blister 2 disposable syringes of 1 ml; in a box of cardboard 1 or 5 blisters.

Description of licarsky form

A glimpse, slightly opalescent, bezbarvny abo svitlo-zhovty rozchin.

characteristic

Low molecular weight heparin (LMWH).

Pharmacological diya

Pharmacodynamics

Nadroparin calcium is characterized by a higher anti-Xa-factor, in proportion to anti-IIa factor or anti-thrombotic activity. Vіdnoshennya mіzh two activities for nadroparіna are in between 2.5-4.

At prophylactic doses, nadroparin does not have an increased decrease in the active partial thrombin hour (APHT).

With a course lіkuvannі in the period of maximum activity, the APTCH can be raised to the value, 1.4 times higher than the standard. Thus, prolongation appears as an excessive antithrombotic effect of nadroparin calcium.

Pharmacokinetics

Pharmacokinetic power is based on the anti-Xa factor activity of plasmas. Pislya p / c introduced mayzhe 100% to the drug shvidko soak. C max in plasma can be reached between 3 and 4 hours, when the nadroparin calcium is consumed in the 2 ін'єкції mode. When nadroparin is consumed with calcium in the mode of 1 ін'єкція for additional C max, it is reached between 4 and 6 years after the introduction. Metabolism is mainly in the liver (desulfation, depolymerization). For subcutaneous administration of T 1/2 of the anti-Xa-factor activity of LMWH in the food, it does not take any non-fractional heparins and becomes 3-4 years old.

At the same time, anti-IIa factor activity is observed, when LMWH is consumed, there is more plasma, there is less anti-Xa factor activity.

Vivedennya is seen in front of nirks, in vyhidnіy abo little changed form.

Groupi Riziku

In lithium ailments, some of the functions of some physiological decrease, eliminations are hopeful. The price does not flow into the dosage and the regimen of the introduction of the drug with a prophylactic method until quietly, as long as the function of nirok cikh ailments is left in the well-groomed boundaries, so that it is slightly damaged.

Until the ear of LMH testing, it is necessary to systematically assess the normal function of lithic ailments in those older than 75 years, the cockroft formula.

Weak to little nirkov deficiency (Cl> 30 ml / min): in some cases, it is possible to control the level of anti-Xa-factor activity in the blood for the prevention of overdose in case of a course drug intake.

Hemodialysis: low-molecular-weight heparin is injected into the arterial line of the loop dialysis in high doses, in order to help keep the blood in the loop. As a matter of principle, pharmacokinetic parameters do not fluctuate, due to the blame of overdose, if the drug is passed into the systemic circulation, it can lead to the anti-Xa factor activity associated with the endocytic phase of nirkovo deficiency.

Indicated to the drug Fraxiparine

Prevention of thrombosis in case of surgical intervention, loss of blood circulation in the system of extracorporeal blood circulation during an hour of hemodialysis or hemophiltraction, thromboembolic acceleration in patients with high risk of thrombosis

Treatment of thromboembolism, unstable angina and myocardial infarction without Q wave.

Prototype

Sensitivity (including thrombocytopenia) to FRAXIPARIN or LMWH and / or heparin in history; signs of bleeding and alterations of the risk of bleeding, dressings with damaged hemostasis, behind the vignette of the syndrome of internal combustion engine, not caused by heparin; organic damage to the organs from the instinct to bleeding (for example, the state of the intestine is twisted or two-fingered intestine); injuries or operative involvement on the central nervous system; septic endocarditis.

Stagnation during vaginosis and breastfeeding

Until the animals did not show a teratogenic effect of nadroparin calcium, protein in the first trimester of vaginosity, it is not uncommon for Fraxiparine to take a prophylactic dose, as well as in the form of a course drug.

Throughout the II and III trimesters of vaginosity, Fraxiparine can be used only as long as the doctor's recommendations for the prevention of venous thrombosis (in case of corystis for the mother with a risik for the fetus). The course of the course in the whole period does not become stagnant.

It is highly recommended to use heparin prophylaxis for at least 12 years prior to anesthesia.

Oskіlki soaktuvannya drug in the intestinal tract in neonatal infants in principle is small, lykuvannya fracsiparin of eternal mothers is not contraindicated.

Pobichna diya

most frequent side effect- education of pediatric hematomas in the center of education. In some cases, the emergence of schilny vuzliks, significant encapsulation of heparin, as they know through a few days, is more likely to appear.

Great doses of Fraxiparine can provoke bleeding in early localizations and mild thrombocytopenia (type I), as it will become involved in the process of other therapy. It is possible for the team to adjust the level of liver enzymes (ALT, AST).

Necrosis of the disease and allergic reactions are rare. I have seen about the decile in anaphylactic reactions and immune thrombocytopenia(Type II), which can be combined with arterial and / or venous thrombosis or thromboembolism.

vzaєmodiya

The development of hypercalculations can be found from the one-hour presence of several factors. Drugs for the treatment of hyperthermia: calcium salts, high-calorie diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, NPZZ, heparin (low-molecular-weight and non-fractional), tacrolimus It is not safe to develop hypercalculation in the combination of food items with FRAXIPARIN.

Alcohol consumption of Fraxiparine with such drugs, which is injected into hemostasis, acetylsalicylic acid, non-steroidal antiapaline substances, antagonists of vitamin K, fibrinolytics and dextran, should be produced to the utmost efficiency.

In addition, next to brothers to respect, it’s ingibitorium of platelet aggregation (including acetylsalicylic acid in the capacity of analgesic and fever-lowering DZ, tobto in a dose of 500 mg): NPZZ, acetylcylic acid, antibacterial shown, beraprost, clopidogrel, eptifibatid, iloprost, ticlopidin, tirofiban, to prevent the development of bleeding.

How to store that dosi

P / c (for the sake of stagnation in the process of hemodialysis).

The given form is intended for grown-ups.

It is not possible to enter the / m!

1 ml of Fraxiparine is equivalent to approximately 9500 IU of anti-Xa-factor activity of nadroparin.

Technology n / a introduction

It is important to put the patient in the position of the bed, in the pediatric tissue of the anterior or posterior cranial girdle, along the right and left side.

The head should be inserted perpendicularly, (and not down the cut), into the pinched fold of the skin, trim with a great and vkazy finger until the end of the introduction. Graduated syringes are intended for the selection of a dose in a fallow form of a sick person.

Prevention of thromboembolism in surgery

Frequency of stagnation. 1 ін'єкція for doba.

Zastosovovana dose. The dose is summed up with an individualized rhizicum, so that it can be deposited as a mass of sick people and as a type of operation.

Situations with a thrombogenic rhizik. at surgical operations To represent a small thrombogenic rhizic, and also in ailments without a thromboembolic rhizic, an effective prevention of thromboembolic ailments is achieved by the administered dose of 2850 MO of anti-Xa factor activity on dobu (0.3 ml).

Pochatkova ін'єкція is guilty but was introduced 2 years before the surgical procedure.

Situations with a thrombogenic rhizik. Operations on the stagnation and the colony: the addition of the nadroparin to lay down as a sick person. Introduce 1 time for additional: 38 MO anti-Xa-factor activity / kg before the operation, that is 12 years before the procedure, when the operation is completed, so that it can be repaired in 12 years after the procedure is completed, then for additional, until the third day of the operation, inclusive; 57 MO anti-Xa-factor activity / kg, repaired from the fourth day of the operation.

Інші situations... In vipads, if thromboembolic rhizik, dressings with the type of operation (especially when oncological operations) І / abo with the individual characteristics of the ailment (especially with thromboembolic ailments in the anamnesis) to give up, to add a dose of 2850 MO anti-Xa-factor activity nadroparin (0.3 ml).

triviality of liking... Lіkuvannya NMG, in the combination with the technology of traditional elastic compression of the lower kinsivok, trivati ​​to the main renewal of the functional function of the sick.

At the out-of-pocket surgery, NMG takes 10 days, when there is a particular rhizic of venous thromboembolism, tied with individual characteristics of the ailment (div. "Special features of stagnation").

As soon as the risk of thromboembolic acceleration is due to the end of the recommended term of treatment, it is necessary to continue prophylactic treatment, for all the help of oral anticoagulants.

However, the common cinnamon from the trivial use of LMWH or antagonists of vitamin K has not been assessed until the end.

Prevention of blood loss in the system of extracorporeal blood circulation during hemodialysis: intravascular(Into the arterial shunt of the loop dializ).

For those who are ill, who will receive repeated sessions of hemodialysis, the prevention of coagulation in the extracorporeal loop of purification can be reached by way of the introduction of a cob dose of 65 MO / kg into the arterial line of the loop for dialogue on the cob.

The dose, which will be stagnant as a one-time intravascular bolus injection, should be taken only for sessions of dialogue, and should last no more than 4 years. Later, the dose may be set in the presence of the individual reaction of the sick person, as it changes in the meaning of the world.

Dozi, how to become stagnant in ailments, in the fallowness from the mastilla, onset:

If necessary, the dose can be changed up to the cutaneous indivisible level and with the help of technical experts. In ailments with increased risk of bleeding, the dialogue can be carried out with a half dose of the drug.

Treatment of glib venous thrombosis (DVT)

Whether the dose was guilty at once, it was confirmed by the results of the previous analyzes.

frequency of consumption... 2 ін'єкції for additional delivery at 12 o'clock

the dose is taken... The dose of cutaneous ін'єкції becomes 85 MO of anti-Xa-factor activity / kg.

Dose of LMW did not grow in the fallowness of the sickness masoyu tila ponad 100 kg or less than 40 kg. In ailments with a weight of more than 100 kg, the efficiency of LMWH can be reduced. From the side of ailments with a mass of less than 40 kg, the rhizik can bleed. Such vipadkas require special clinical control.

For the given dose, the dose that stagnates in the fallowness of the sickness becomes 0.1 ml / 10 kg of the skin 12 years old, as shown in the table below:

The triviality of love. Lіkuvannya LMG has been quickly replaced by oral anticoagulants, with a blame for quiet vipadkіv, if the remainder of the evidence. The triviality of LMG's triviality is not to blame for 10 days, including the period of switching to antagonism to Vitamin K (AVK), behind the blame is quiet vipadk, since there are difficult stabilizations of MNO (div. "Osobennosti"). In such a rank, the use of oral anticoagulants is guilty of being used in the past.

Treatment of unstable angina / myocardial infarction without Q wave change

Frequency of stagnation. Nadroparin calcium stagnates in viglyadi two p / c in'ktsiy on dobu (with an interval at 12 o'clock), dermal in a dose of 86 MO anti-Xa-factor activity, in combination with aspirin (recommended dose of 75-325 mg in the middle, dose 160 mg).

Zastosovovana dose. The pochatkova dose should be injected with an i / v bolus at a dose of 86 MO anti-Xa / kg, then s / c in the same dose.

Overdose

In case of overdosage with subcutaneous administration of large doses of LMWH, I may bleed.

At the time of taking in all the middle - to navigate a masovanoy dose - LMWH (until now, it was not meant), there are no serious inheritances, because the absorption of the drug is already low.

lykuvannya: if there is little bleeding, add the Chergov dose.

In some cases, it is possible to show the intake of protamine sulfate, with an attack of the offensive: its efficiency is lower, it is described below in connection with the overdose of unfractionated heparin; cinnamon / rhizic protamin sulfate is highly estimated, in conjunction with yogo side by side(Especially anaphylactic shock).

As soon as it is done, the neutralization is carried out by the intravenous injection of protamine sulfate.

An effective dose of protamine sulfate is stored: as a dose of heparin (100 antiheparin single unit of protamine sulfate can be used to neutralize the activity of 100 IU of anti-Xa-factor activity of LMWH); an hour after the introduction of heparin, we can change the dose of the antidote.

However, I will not increase the neutralization of anti-Xa factor activity.

Moreover, the kinetics of absorption of low-molecular-weight heparin can lead to the neutralization of the hourly nature and the fragmentation of the repeated roasted dose of protamine sulfate on a spike in the form (2-4), additionally.

special requests

Unimportant to the current concentration of low-molecular-weight heparins, the anti-Xa-factor activity is found in the international units of anti-Xa-factor activity; Replacing the dosage regimen of one LMWH is not safe and unacceptable, because the skin mode is enhanced by special clinical vapors. This requires special care and attention to specific instructions and prescription for a skin drug.

Rizik bleeding. It is necessary to take the recommended therapeutic regimes (dosage and triviality of treatment). In protylezhny vipadu there may be some bleeding, especially in ailing groups (lithium individuals, patients, who suffer for a lack of nirkov, etc.).

Serioznі bleeding spasterіgalis: in young ailments, especially in connection with weakened function nirok z vіkom; with nirkovy deficiency; in ailments with a weight less than 40 kg; in times of triviality, I recommend it (10 days); in the case of a lack of recommended minds for the exchange (especially the triviality and establishment of a dose on the basis of the basis for a course payment); with a combination of drugs, which will increase the risk of bleeding.

In any case, there is a need for special control in patients with ailments and ailments, who suffer for nirkov deficiency, as well as when the drug is trivial for 10 days. For the effect of accumulation of the drug in some types of drops, it can be used as anti-Xa factor activity.

Rizik heparin-induced thrombocytopenia (HIT). In case of a person who is sick, who will reject the use of LMWH (in course of abnormal prophylactic doses), it means: negative dynamics of thrombosis, causing any patient to get caught up, phlebitis, embolism of the legenevicus, gostra ishemia lower symptoms, myocardial infarction or an insult, the next step is to look at the manifestation of heparin-induced thrombocytopenia (HIT), and it is inaccurate to analyze the number of thrombocytes.

Zastosuvannya in children. It is not recommended to use LMWH in children because of the availability of gifts.

Function nirok. Before the cob of LMH drinking, it is necessary to control the function of nirok, especially in the case of old people who are older than 75 years. Clirence to creatine growth according to Cockroft's formula and on the basis of the actual weight of the sick person: in people, Cl creatine = (140-c) × weight of the alcohol / (0.814 × creatine of the syrovate), in the range of the creatine in the amount of kg, micron / l (as creatine is expressed in mg / ml, multiply by 8.8).

For women, the formula will increase the multiplier result by 0.85.

The appearance of a severe nirkovo deficiency (Cl creatinine is close to 30 ml / h) becomes a contraindication of LMWH consumption in course form (div. "Prototype").

laboratory control

Thrombocyte count control

Heparin-induced thrombocytopenia

At the connection with a non-safe development of GIT, it is necessary to control the number of thrombocytes; Take the number of thrombocytes until the cob is taken, or not by pulling one ear to the ear, but then 2 times for a day, stretching the whole course of the test.

Diagnosis of HIT should be delayed, as well as the number of thrombocytes<100000/мм 3 и/или наблюдается падение числа тромбоцитов на 30-50% по отношению к предыдущему анализу. Она развивается в основном между 5 и 21 днем после начала лечения гепарином (с максимальной частотой — около 10 дня).

However, it may appear significantly earlier for a history of sick thrombocytopenia, associated with heparin drugs, in even worse cases, and after 21 days. The collection of such anamnesis should be systematically carried out in the course of spivation from sickness to the ear of treatment. In addition, the risk of HIT diagnostics when re-injected with heparin can be taken for a prolonged period of time or for an unassigned hour (div. "Prototype indication").

In any case, the opinion of the GIT in an inaccessible situation and in the meeting with the Fakhivtsy. If there is a decrease in the number of thrombocytes (by 30-50% of the cob value), you will be guilty of looking at the alarm signal until the critical values ​​are reached. If the number of thrombocytes falls, it is necessary: ​​to accurately control the number of thrombocytes.

If the heparin was introduced, it was confirmed if it was detected under the control, for the duration of the other obvious reasons.

Add blood samples to a citrate tube for further platelet aggregation in vitro and immunological analysis. However, in such situations, inadvertently, do not go into the results of these analyzes. Unimportant at the price of the analysis, the guilt was carried out for the establishment of an accurate diagnosis of the acceleration, therefore, with the advanced treatment with heparin, the risk of thrombosis is even greater.

Improve the prevention and treatment of thrombotic acceleration of HIT.

As soon as it appears, it is necessary to continue anticoagulant therapy, heparin is to blame for the replacement by a higher class of antithrombotic drugs: sodium danaparoid or hips, which is important in preventive doses for health problems.

I will replace the antagonism with vitamin K, it is possible to carry out only when the number of platelets is normalized, in conjunction with the risik, to make the thrombotic effect stronger.

Replacing heparin with an antagonist of vitamin K... In the end, there was a need for clinical and laboratory control to watch out for the effects of the antagonist to V.K.

Oscillations outside the antagonist of vitamins To manifest themselves not all at once, heparin should be injected in an equivalent dose, as long as it is necessary to achieve what is needed for this, the level of INR is shown in two last analogs.

Control of anti-Xa-factor activity... A large number of clinical vip tests, which demonstrated the effectiveness of LMWH, was carried out in doses that were set in the amount of sick people and without any special laboratory control, the value of this type of control for the assessment of low blood pressure. However, laboratory control by a path of anti-Xa-factor activity can be used in case of a risk of bleeding in certain clinical situations, often associated with an overdose.

The situation may be an indication for the course consumption of LMWH, in conjunction with the stagnant doses, with weak and moderate deficiencies (Cl, insurance for the Cockcroft formula, 30-60 ml / hv): efficiently, against the standard of non-cancer in the main nirkami, and the function is ruined, it can lead to an overdose. To be ashamed of an important shortcoming, there is a counter-indication of the storage of LMW in the course mode (div. "Prototype indication"); with extreme body weight (decreased body weight or increased weight, obesity); with unexplained bleeding.

For reintroduction, it is recommended to take shelter from a sick person as soon as possible at maximum activity of the drug (apparently before the obvious dues), so that:

Approximately 4 years later, after the third injection, when the drug stays in the form of two p / to the injections for additional, or after about 4 years, after another injection, as the drug stagnates in the form of one p / to in the end.

Repeated determination of anti-Xa-factor activity for the reduction of heparin level in syrovattsi - skin 2 or 3 days - it is necessary to look at the skin margin, in the presence of results in the foregoing analysis, if necessary, modifying the dosage.

For the cutaneous LMWH and for the cutaneous therapeutic regimen, anti-Xa factor activity is generated.

As a matter of fact, it is obvious that the average anti-Xa-factor activity (± standard results) is needed to last for the fourth year after the introduction of nadroparin in a dose:

83 MO / kg in viglyadі two in'єktsіy on dobu, became 1.01 ± 0.18 MO

168 MO / kg in viglyadi of one in''ktsiya for doba, became 1.34 ± 0.15 MO

The average value was observed in the course of clinical tests for anti-Xa-factor activity, which was carried out using the tests of the chromogenic (amidolytic) method.

Activation of partial thromboplastin hour (APHT)... Deyaki NMG podovzhuyut APHT. (Not too classy).

Conducting spinal / epidural anesthesia in the context of prophylactic administration of LMWH... With LMWH stagnation, as well as other anticoagulants, during spinal anesthesia or epidural anesthesia, there were single episodes of intraspinal hematoma, which lead to trivial abnormal parallels.

Rizik of intraspinal hematomy, mabut, more high in case of an epidural catheter, less in case of stasis of spinal anesthesia.

A failure to diagnose a medical acceleration can be improved if the epidural catheter is stuck in a tricky state after surgical intervention.

Yakscho peredoperatsіyne lіkuvannya LMWH neobhіdno (under study is іmmobіlіzatsіya, trauma) and perevagi spinal mozkovoї anestezії retelno otsіnenі, Qiu tehnіku mozhna zastosuvati have ailing, yaky otrimav to operatsії іn'єktsіyu LMWH Yakscho mіzh іn'єktsієyu heparin that zastosuvannyam spinnomozkovogo anesthetic proyshov perіod not less than 12 years old. At the connection with an unsafe diagnosis of intraspinal hematoma and the necessary retelny neurological control.

In all cases, the prophylactic treatment of LMWH can be repeated for 6-8 years for an anesthetic or catheter injection, with neurological control.

Particularly safe is required in the case of a combination of other drugs, which is injected into hemostasis (and the refinery itself, acetylsalicylic acid).

Chi does not flow into the health of the keruvati by car and pratsyuvati at verstats.

Vikoristannya sistemi zahistu golki: after the introduction of the drug zastosovuvati a system of baked goods for the Fraxiparin syringe. Tighten the syringe in one hand for the zaschisny body, with your hand pull on the holder for sucking in and out of the chohla for capturing the head to the click. Vikoristan's golka has been seized.

Virobnik

Sanofi Winthrop Industry, France.

Mind the drug Fraxiparine

Zberigati out of the reach of children.

The term of attachment to the drug Fraxiparin

Do not fix the message for the end of the term of accessibility indicated on the package.

Synonyms of nosological groups