The hypercoagulable State treatment2017-01-24 16:01
Changes due to coagulation factors in patients with nephrotic syndrome in a hypercoagulable State, especially when albumin is lower than 20~25g/L, and venous thrombosis. Now commonly used anticoagulants include:
(1) heparin: mainly through activation of Antithrombin III (AT III) activity. Commonly used doses of intravenous infusion of 50~75mg/d, ⅲ activity unit AT 90%. Reported that heparin can reduce nephrotic syndrome with proteinuria and improve renal function, but its mechanism of action is not clear. It is noteworthy that heparin (MW65600) can cause platelet aggregation. There are low molecular weight heparin subcutaneous injection once daily.
(2) urokinase (UK): directly activates plasminogen, resulting in fibrinolysis. Commonly used doses of 2~8 million U/d, using small dose to start, and can be used with intravenous drip of heparin at the same time. Monitoring euglobulin Lysis time, make it 90-120 minutes. UK's main side effect is hypersensitivity and bleeding.
(3) warfarin: vitamin k-dependent inhibition of hepatic cell factor II, VII, IX, and x, the synthesis of dose 2.5mg/d oral, monitoring of prothrombin time, make it a normal 50%~70%.
(4) dipyridamole: platelet antagonists, commonly used dose of 100~200mg/d. Intravenous anticoagulation for 2-8 weeks of hypercoagulable State, later changed to oral warfarin/dipyridamole.
Venous thrombosis: ① surgery to remove blood clots. ② Interventional thrombolysis. Interventional Radiology in renal arteries end once injected UK24 Wan u to dissolve the Renal vein thrombosis, this method can be repeated. ③ systemic intravenous anticoagulation. Heparin and urokinase for 2-3 months. ④ oral warfarin to nephrotic syndrome remission to prevent blood clots forming.