Bivalirudindomin allura

250mg/vial Ƙarfin

Nuni:BivalirudinAn nuna don amfani azaman maganin ƙwanƙwasa jini a cikin marasa lafiya da ke jure wa cututtukan zuciya na percutaneous (PCI).

Aikace-aikacen asibiti: Ana amfani da shi don allurar cikin jijiya da ɗigon ruwa.

ALAMOMIN DA AMFANI

1.1 Percutaneous Transluminal Coronary Angioplasty (PTCA)

Ana nuna Bivalirudin don allura don amfani azaman maganin hana ruwa a cikin marasa lafiya tare da angina mara ƙarfi da ke jurewa percutaneous transluminal coronary angioplasty (PTCA).

1.2 Tsangwama na Ciwon Jiki (PCI)

Bivalirudin don allura tare da amfani na wucin gadi na glycoprotein IIb/IIa inhibitor (GPI) kamar yadda aka jera a cikin

Ana nuna gwaji na REPLACE-2 don amfani azaman maganin ƙwanƙwasa jini a cikin marasa lafiya da ke jure wa cututtukan zuciya na percutaneous (PCI).

Ana nuna Bivalirudin don allura ga marasa lafiya tare da, ko kuma a cikin haɗarin, heparin induced thrombocytopenia (HIT) ko heparin induced thrombocytopenia da thrombosis ciwo (HITTS) jurewa PCI.

1.3 Muna da Aspirin

Bivalirudin don allura a cikin waɗannan alamun an yi nufin amfani da aspirin kuma an yi nazari ne kawai a cikin marasa lafiya da ke karɓar aspirin.

1.4 Iyakance Amfani

Ba a kafa aminci da tasiri na bivalirudin don allura ba a cikin marasa lafiya da ke fama da cututtuka masu tsanani waɗanda ba su da PTCA ko PCI.

2 SAUKI DA GWAMNATI

2.1 Yawan Shawarar

Bivalirudin na allura don gudanar da jijiya ne kawai.

Bivalirudin don allura an yi niyya don amfani da aspirin (300 zuwa 325 MG kowace rana) kuma an yi nazari ne kawai a cikin marasa lafiya da ke karɓar aspirin.

Ga marasa lafiya waɗanda ba su da HIT/HITTS

Maganin da aka ba da shawarar na bivalirudin don allura shine kashi na jini (IV) na bolus na 0.75 mg / kg, wanda ya biyo baya nan da nan ta hanyar jiko na 1.75 mg / kg / h don tsawon lokacin tsarin PCI / PTCA. Minti biyar bayan an gudanar da kashi na bolus, yakamata a yi lokacin kunna clotting (ACT) kuma a ba da ƙarin bolus na 0.3 mg/kg idan an buƙata.

Ya kamata a yi la'akari da gudanar da GPI idan duk wani yanayi da aka jera a cikin bayanin gwajin asibiti na REPLACE-2 ya kasance.

Ga marasa lafiya da ke da HIT/HITTS

Matsakaicin shawarar bivalirudin don allura a cikin marasa lafiya tare da HIT/HITTS da ke jurewa PCI shine bolus IV na 0.75 mg/kg. Wannan ya kamata a bi shi ta hanyar ci gaba da jiko a cikin adadin 1.75 mg / kg / h don tsawon lokacin aikin.

Don ci gaba da jiyya bayan hanya

Bivalirudin don jiko na allura na iya ci gaba da bin PCI/PTCA har zuwa sa'o'i 4 bayan aikin bisa ga shawarar likitan da ke kula da su.

A cikin marasa lafiya tare da ST segment elevation myocardial infarction (STEMI) ci gaba da bivalirudin don jiko na allura a cikin adadin 1.75 mg / kg / h bayan PCI / PTCA har zuwa sa'o'i 4 bayan tsari ya kamata a yi la'akari da shi don rage haɗarin thrombosis stent.

Bayan sa'o'i hudu, za a iya fara ƙarin jiko na IV na bivalirudin don allura a cikin adadin 0.2 mg / kg / h (jiko mai ƙarancin kuɗi), har zuwa sa'o'i 20, idan an buƙata.

2.2 Dosing a Lalacewar Renal

Ba a buƙatar raguwa a cikin kashi na bolus don kowane mataki na lahani na koda. Matsakaicin jiko na bivalirudin don allura na iya buƙatar ragewa, kuma ana kula da matsayin anticoagulant a cikin marasa lafiya da nakasa na koda. Marasa lafiya tare da matsakaicin raunin koda (30 zuwa 59 ml / min) yakamata su sami jiko na 1.75 mg/kg/h. Idan izinin creatinine bai wuce 30 ml / min ba, yakamata a yi la'akari da rage yawan jiko zuwa 1 mg / kg / h. Idan majiyyaci yana kan hemodialysis, yakamata a rage yawan jiko zuwa 0.25 mg/kg/h.

2.3 Umarni don Gudanarwa

Bivalirudin don allura an yi niyya don allurar bolus na ciki da ci gaba da jiko bayan sake gyarawa da dilution. Ga kowane vial na 250 MG, ƙara 5 ml na Ruwan Bakararre don allura, USP. A hankali a juya har sai duk kayan ya narke. Bayan haka, cire kuma zubar da 5 ml daga jakar jiko na 50 ml mai dauke da 5% Dextrose a cikin Ruwa ko 0.9% Sodium Chloride don allura. Sa'an nan kuma ƙara abubuwan da ke cikin vial ɗin da aka sake ginawa zuwa jakar jiko mai dauke da 5% Dextrose a cikin Ruwa ko 0.9% Sodium Chloride don allura don samar da taro na ƙarshe na 5 mg / ml (misali, 1 vial a cikin 50 ml; 2 vials a cikin 100 ml; 5 gwangwani a cikin 250 ml). Adadin da za a yi amfani da shi yana daidaitawa gwargwadon nauyin mai haƙuri (duba Table 1).

Idan an yi amfani da jiko maras nauyi bayan jiko na farko, ya kamata a shirya jakar maida hankali. Domin shirya wannan ƙananan maida hankali, sake sake fasalin 250 MG tare da 5 ml na Ruwa mara kyau don allura, USP. A hankali a juya har sai duk kayan ya narke. Bayan haka, cire kuma zubar da 5 ml daga jakar jiko na 500 ml mai dauke da 5% Dextrose a cikin Ruwa ko 0.9% Sodium Chloride don allura. Sa'an nan kuma ƙara abin da ke cikin vial ɗin da aka sake ginawa a cikin jakar jiko mai ɗauke da 5% Dextrose a cikin Ruwa ko 0.9% Sodium chloride don allura don samar da taro na ƙarshe na 0.5 mg/mL. Ya kamata a zaɓi adadin jiko da za a gudanar daga ginshiƙi na hannun dama a cikin Tebur 1.