Антикоагулянт прямого действия, относится к группе среднемол... Инструкция
Показания к применению
Тромбофлебит поверхностных вен; локализованные инфильтраты и отеки мягких тканей; травмы сухожилий и суставов, ушибы мягких тканей и суставов.
Противопоказания
Повышенная чувствительность к какому-либо из компонентов препарата, язвенно-некротические изменения кожи в местах предполагаемого нанесения геля, травматическое нарушение целостности кожных покровов, пониженная свертываемость крови, тромбоцитопения.
Антикоагулянт прямого действия, относится к группе среднемолекулярных гепаринов. в плазме крови активирует антитромбин iii, ускоряя его противосвертывающее действие. нарушает переход протромбина в тромбин, угнетает активность тромбина и активированного фактора x, в некоторой степени уменьшает агрегацию тромбоцитов.для нефракционированного стандартного гепарина соотношение антиагрегантной активности (антифактора xa) и антикоагулянтной активности (ачтв) составляет 1: 1.увеличивает почечный кровоток; повышает сопротивление сосудов мозга, уменьшает активность мозговой гиалуронидазы, активирует липопротеинлипазу и обладает гиполипидемическим действием. снижает активность сурфактанта в легких, подавляет чрезмерный синтез альдостерона в коре надпочечников, связывает адреналин, модулирует реакцию яичников на гормональные стимулы, усиливает активность паратгормона. в результате взаимодействия с ферментами может увеличивать активность тирозингидроксилазы мозга, пепсиногена, днк-полимеразы и снижать активность миозиновой атфазы, пируваткиназы, рнк-полимеразы, пепсина.имеются данные о наличии у гепарина иммунодепрессивной активности.у больных с ибс (в комбинации с аск) снижает риск развития острых тромбозов коронарных артерий, инфаркта миокарда и внезапной смерти. уменьшает частоту повторных инфарктов и летальность больных, перенесших инфаркт миокарда. в высоких дозах эффективен при тромбоэмболиях легочной артерии и венозном тромбозе, в малых - для профилактики венозных тромбоэмболий, в т.ч. после хирургических операций.при в/в введении свертывание крови замедляется почти сразу, при в/м - через 15-30 мин, при п/к - через 20-60 мин, после ингаляции максимум эффекта - через сутки; продолжительность антикоагулянтного действия соответственно - 4-5, 6, 8 ч и 1-2 нед., терапевтический эффект - предотвращение тромбообразования - сохраняется значительно дольше. дефицит антитромбина iii в плазме или в месте тромбоза может снизить антитромботический эффект гепарина.при наружном применении оказывает местное антитромботическое, антиэкссудативное, умеренное противовоспалительное действие. блокирует образование тромбина, угнетает активность гиалуронидазы, активирует фибринолитические свойства крови. проникающий через кожу гепарин уменьшает воспалительный процесс и оказывает антитромботическое действие, улучшает микроциркуляцию и активирует тканевой обмен, благодаря этому ускоряет процессы рассасывания гематом и тромбов и уменьшения отечности тканей.
Показания к применению
Тромбофлебит поверхностных вен; локализованные инфильтраты и отеки мягких тканей; травмы сухожилий и суставов, ушибы мягких тканей и суставов.
Противопоказания
Повышенная чувствительность к какому-либо из компонентов препарата, язвенно-некротические изменения кожи в местах предполагаемого нанесения геля, травматическое нарушение целостности кожных покровов, пониженная свертываемость крови, тромбоцитопения.
Применение при беременности и в период грудного вскармливания
Применение при беременности возможно только по строгим показаниям, под тщательным медицинским контролем. Возможно применение в период лактации (грудного вскармливания) по показаниям.
Способ применения и дозы
Наружно. Гель наносят тонким слоем на область поражения из расчета 3-5 см геля на участок кожи диаметром 3-5 см и осторожно втирают в кожу. Применяют 1-3 раза в сутки ежедневно до исчезновения воспалительных явлений, в среднем от 3 до 7 дней. Сроки лечения определяются врачом.
Побочное действие
Кожные аллергические реакции, гиперемия кожи.
Особые указания
C осторожностью применять у пациентов, страдающих поливалентной аллергией (в т.ч. при бронхиальной астме), при артериальной гипертензии, стоматологических манипуляциях, сахарном диабете, эндокардите, перикардите, при наличии внутриматочного контрацептива, при активном туберкулезе, лучевой терапии, печеночной недостаточности, хронической почечной недостаточности, у пациентов пожилого возраста (старше 60 лет, особенно женщины). Не рекомендуется в/м введение гепарина из-за возможности развития гематомы, а также в/м введение других препаратов на фоне лечения гепарином. С осторожностью применяют наружно при кровотечениях и состояниях повышенной кровоточивости, тромбоцитопении. Во время лечения гепарином необходим контроль показателей свертывания крови. Для разведения гепарина используют только физиологический раствор. При развитии тяжелой тромбоцитопении (снижение количества тромбоцитов в 2 раза от первоначального числа или ниже 100 000/мкл) необходимо срочно прекратить применение гепарина. Риск кровотечения может быть сведен до минимума при тщательной оценке противопоказаний, регулярном лабораторном контроле свертывания крови и адекватном дозировании.
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