利伐沙班能去除血栓吗

(Rivaroxaban) is an oral factor Xa inhibitor that can dose-dependently inhibit plasma free factor Xa and factor Xa in the prothrombin complex to prevent the coagulation activation process and ultimately achieve the prevention and treatment of thrombosis. In clinical practice, rivaroxaban can dissolve thrombus, but it cannot directly remove thrombus. However, in a sense, it also removes thrombus indirectly.

Rivaroxaban is a competitive inhibitor of factor The half-life of rivaroxaban is 5 to 13 hours (the half-life of elderly people is longer than that of young adults). The plasma protein binding rate is about 92%~95%, and it has high bioavailability (10 mg rivaroxaban, 80%~100%) when the body is well-nourished. The bioavailability of 15 and 20 mg rivaroxaban is reduced in the fasting state. Rivaroxaban is a substrate of the efflux transporter (P-glycoprotein), metabolized by the CYP3A4 isoenzyme, and is 67% eliminated by the kidneys (metabolic degradation and unchanged form).

A foreign study shows that when the plasma concentration of rivaroxaban (i.e. Xarelto) is <20 ng/ml, intravenous thrombolysis is recommended; when the plasma concentration is between 20 and 100 ng/ml, thrombolysis is considered, and when the plasma concentration is >100 ng/ml, the possibility of thrombolysis is ruled out; for patients with intracranial arterial occlusion, thrombolysis plus intravascular therapy is recommended when the plasma level is ≤100 ng/ml, and when >100 ng/ml, pure endovascular therapy was performed.

In this study, measurement of plasma levels of rivaroxaban enabled treatment of nearly one-third of patients who were originally considered ineligible for emergency intravenous thrombolysis. In addition, no bleeding events occurred in any of the 114 patients used in this study.

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