{"id":9320,"date":"2019-05-09T11:55:29","date_gmt":"2019-05-09T04:55:29","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=9320"},"modified":"2019-05-11T11:57:40","modified_gmt":"2019-05-11T04:57:40","slug":"lieu-phap-dieu-tri-bo-sung-moi-cho-benh-dong-mach-vanh","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/lieu-phap-dieu-tri-bo-sung-moi-cho-benh-dong-mach-vanh\/","title":{"rendered":"Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung m\u1edbi cho b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh"},"content":{"rendered":"<h2>\u0110i\u1ec3m tin nghi\u00ean c\u1ee9u m\u1edbi \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1: Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung m\u1edbi cho b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/h2>\n<p>Rivaroxaban v\u00e0 icosapentethylare l\u00e0 nh\u1eefng li\u1ec7u ph\u00e1p b\u1ed5 sung ti\u1ec1m n\u0103ng.<\/p>\n<p>M\u1ed9t s\u1ed1 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung m\u1edbi cho b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (CAD) \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u ho\u1eb7c ph\u00ea duy\u1ec7t v\u00e0o n\u0103m 2018.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8435 aligncenter\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/xarelto_gia_bao_nhieu.jpg\" alt=\"xarelto\" width=\"450\" height=\"450\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/xarelto_gia_bao_nhieu.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/xarelto_gia_bao_nhieu-280x280.jpg 280w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/xarelto_gia_bao_nhieu-400x400.jpg 400w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/xarelto_gia_bao_nhieu-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/xarelto_gia_bao_nhieu-100x100.jpg 100w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><\/p>\n<p>G\u1ea7n d\u00e2y FDA \u0111\u00e3 ch\u1ea5p thu\u1eadn ng\u01b0\u1ee1ng li\u1ec1u m\u1edbi c\u1ee7a rivarobaxan (Xarelto) l\u00e0 2,5 mg, d\u1ef1a tr\u00ean m\u1ed9t th\u1eed nghi\u1ec7m quy m\u00f4 l\u1edbn tr\u00ean 27000 b\u1ec7nh nh\u00e2n CAD c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c c\u00f3 t\u00e1i t\u01b0\u1edbi m\u00e1u m\u1ea1ch v\u00e0nh ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng b\u1ec7nh l\u00ed m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean. Nh\u1eefng b\u1ec7nh nh\u00e2n CAD d\u01b0\u1edbi 65 tu\u1ed5i ph\u1ea3i c\u00f3 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch tr\u00ean m\u1ed9t v\u1ecb tr\u00ed m\u1ea1ch kh\u00e1c ho\u1eb7c c\u00f3 \u00edt nh\u1ea5t 2 y\u1ebfu t\u1ed1 nguy c\u01a1. C\u00e1c ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb bao g\u1ed3m: c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao, c\u00e1c b\u1ec7nh m\u1eafc k\u00e8m nghi\u00eam tr\u1ecdng, t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn &lt;15 mL\/ph\u00fat, suy tim n\u1eb7ng v\u00e0 c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean \u0111i\u1ec1u tr\u1ecb b\u1eb1ng rivarobaxan (2,5 mg 2 l\u1ea7n\/ng\u00e0y) k\u1ebft h\u1ee3p aspirin (100 mg\/ng\u00e0y), rivarobaxan \u0111\u01a1n \u0111\u1ed9c (5mg 2 l\u1ea7n\/ng\u00e0y) ho\u1eb7c aspirin \u0111\u01a1n \u0111\u1ed9c. Trong 2 n\u0103m \u0111i\u1ec1u tr\u1ecb, t\u1ec9 l\u1ec7 m\u1eafc c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch b\u1ea5t l\u1ee3i c\u1ee7a nh\u00f3m k\u1ebft h\u1ee3p rivarobaxan v\u00e0 aspirin th\u1ea5p h\u01a1n 1,3% so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb aspirin \u0111\u01a1n \u0111\u1ed9c, nh\u01b0ng t\u1ec9 l\u1ec7 ch\u1ea3y m\u00e1u l\u1ea1i cao h\u01a1n 1,2% (NEJM JW Gen Med ng\u00e0y 1\/10\/2017 v\u00e0 N Engl J Med ng\u00e0y 5\/10\/2017; 377:1319).<\/p>\n<p>\u1ede m\u1ed9t th\u1eed nghi\u1ec7m kh\u00e1c, b\u1ec7nh nh\u00e2n m\u1eafc CAD ho\u1eb7c m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng k\u00e8m c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c c\u00f3 n\u1ed3ng \u0111\u1ed9 triglycerid cao d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng statin \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean \u0111\u1ec3 s\u1eed d\u1ee5ng icosapent ethyl (Vascepa, m\u1ed9t ethyl ester c\u1ee7a acid b\u00e9o \u03c9-3 acid eicosaentaenoic) ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c l\u00e0 d\u1ea7u kho\u00e1ng. Sau trung b\u00ecnh 4,9 n\u0103m theo d\u00f5i, ch\u1ec9 ti\u00eau \u0111\u00e1nh gi\u00e1 g\u1ed9p ph\u1ee5 bao g\u1ed3m t\u1ec9 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng g\u00e2y t\u1eed vong ho\u1eb7c \u0111\u1ed9t qu\u1ef5 c\u1ee7a nh\u00f3m d\u00f9ng icosapent ethyl h\u01a1i th\u1ea5p h\u01a1n nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (17% so v\u1edbi 22%). T\u1ec9 l\u1ec7 rung nh\u0129 v\u00e0 cu\u1ed3ng \u0111\u1ed9ng nh\u0129 \u1edf nh\u00f3m icosapent ethyl cao h\u01a1n nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (3.1 % so v\u1edbi 2,1 %), nh\u00f3m icosapent ethyl c\u0169ng c\u00f3 nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u h\u01a1n. S\u1eed d\u1ee5ng icosapent ethyl so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c cho ch\u1ec9 ti\u00eau \u0111\u00e1nh gi\u00e1 g\u1ed9p ch\u00ednh (bao g\u1ed3m g\u1ed3m t\u1ec9 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng g\u00e2y t\u1eed vong, \u0111\u1ed9t qu\u1ef5 kh\u00f4ng g\u00e2y t\u1eed vong, t\u00e1i t\u01b0\u1edbi m\u00e1u m\u1ea1ch v\u00e0nh ho\u1eb7c \u0111au ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh) th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 trong qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t (kho\u1ea3ng 71% b\u1ec7nh nh\u00e2n) nh\u01b0ng kh\u00f4ng th\u1ea5p h\u01a1n trong qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t (NEJM JW Gen Med Jan 1 2019 v\u00e0 N Engl J Med Nov 10);<\/p>\n<p>C\u1ea3 rivaroxaban v\u00e0 icosapent ethyl \u0111\u1ec1u l\u00e0 li\u1ec7u ph\u00e1p b\u1ed5 sung ti\u1ec1m n\u0103ng cho b\u1ec7nh nh\u00e2n CAD. Trong nghi\u00ean c\u1ee9u COMPASS, l\u1ee3i \u00edch c\u1ee7a c\u00e1c li\u1ec7u ph\u00e1p ch\u1ec9 nh\u1ec9nh h\u01a1n so v\u1edbi c\u00e1c nguy c\u01a1, c\u00e1c b\u00e1c s\u0129 c\u00f3 l\u1ebd ch\u1ec9 n\u00ean s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p cho b\u1ec7nh nh\u00e2n \u0111\u1ea1t ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn c\u1ee7a nghi\u00ean c\u1ee9u.<\/p>\n<p>M\u1eb7c d\u00f9 ph\u00e2n t\u00edch d\u01b0\u1edbi nh\u00f3m trong th\u1eed nghi\u1ec7m icosapent ethyl kh\u00f4ng ph\u1ea3i th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, icosapent ethyl c\u0169ng ch\u1ec9 n\u00ean s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n \u0111\u00e3 m\u1eafc CAD, do thu\u1ed1c kh\u00f4ng \u0111em l\u1ea1i l\u1ee3i \u00edch d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t trong th\u1eed nghi\u1ec7m n\u00e0y c\u0169ng nh\u01b0 trong c\u00e1c th\u1eed nghi\u1ec7m v\u1ec1 d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t b\u1eb1ng c\u00e1c acid \u03c9-3 g\u1ea7n \u0111\u00e2y.<\/p>\n<p>Ngu\u1ed3n: T\u00e1c gi\u1ea3 Kirsten E. Fleischmann, MD, MPH, FACC<\/p>\n<p><a href=\"https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018\" rel=\"noopener\">https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018<\/a><\/p>\n<p>Ng\u01b0\u1eddi t\u1ed5ng h\u1ee3p: Nguy\u1ec5n Th\u1ecb Thu H\u00e0 &#8211; \u0110o\u00e0n Ph\u01b0\u01a1ng Th\u1ea3o<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec3m tin nghi\u00ean c\u1ee9u m\u1edbi \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1: Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung m\u1edbi cho b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Rivaroxaban v\u00e0 icosapentethylare l\u00e0 nh\u1eefng li\u1ec7u ph\u00e1p b\u1ed5 sung ti\u1ec1m n\u0103ng. M\u1ed9t s\u1ed1 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung m\u1edbi cho b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (CAD) \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u ho\u1eb7c ph\u00ea duy\u1ec7t v\u00e0o n\u0103m [&#8230;]\n","protected":false},"author":1,"featured_media":8436,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9320","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/9320","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=9320"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/9320\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/8436"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=9320"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=9320"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=9320"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}