{"id":9312,"date":"2020-04-23T04:34:25","date_gmt":"2020-04-23T01:34:25","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/timp-de-protrombina-quick\/"},"modified":"2026-02-19T01:37:55","modified_gmt":"2026-02-18T23:37:55","slug":"timp-de-protrombina-quick","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/timp-de-protrombina-quick\/","title":{"rendered":"\u041f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u043e\u0432\u043e\u0435 \u0432\u0440\u0435\u043c\u044f QUICK"},"content":{"rendered":"

Sinonim<\/em><\/strong> \u2013 timp Quick,\u00a0<\/b>include\u00a0<\/b>INR<\/span><\/p>\n

\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/span><\/p>\n

Timpul\u00a0 de protrombina (PT) evalueaza activitatea factorilor\u00a0 implicati pe calea\u00a0\u201cextrinseca\u201d si \u201ccomuna\u201d a coagularii\u00a0: FVII-proconvertina, FX-factorul Stuart-Prower, FV-proaccelerina, FII-protrombina si FI-fibrinogenul.<\/span><\/p>\n

Factorii coagularii II, VII, IX si X sunt sintetizati in ficat sub forma inactiva (PIVKA). Aceste proteine (alaturi de proteinele C, S si Z) au in comun reziduurile unice de acid \u03b3-glutamil carboxilic (Gla) la capatul N-terminal al moleculei, care necesita prezenta vitaminei K pentru sinteza si care sunt esentiale pentru legarea calciului, servind ca punte pentru legarea proteinei la suprafata fosfolipidica, respectiv pentru a fi functionale.<\/span><\/p>\n

Ca urmare PT evalueaza atat activitatea factorilor de coagulare\u00a0 dependenti de vitamina K (mai putin FIX), a factorului V si a fibrinogenului, cat si functia de sinteza proteica a ficatului, cu implicatii diagnostice si terapeutice2<\/sup>.<\/span><\/p>\n

In vivo<\/em>, principala cale de initiere a coagularii sangelui este sistemul extrinsec, care include componente din sange si elementele vasculare, initierea coagularii survenind cand factorul tisular (FT) este legat de FVIIa. Complexul enzimatic FVIIa-FT activeaza atat FIX cat si FX, FX fiind un substrat mai eficient. FXa interactioneaza cu cofactorul sau FVa pentru a forma complexul protrombinazic, suficient pentru a genera o foarte mica cantitate de trombina in vecinatatea celulelor care exprima FT.<\/span><\/p>\n

In vitro<\/em>, <\/strong>PT masoara timpul scurs intre adaugarea unei mixturi standardizate de tromboplastina tisulara si calciu la o plasma anticoagulata cu citrat, saraca in trombocite si detectia formarii cheagului, reprezentand polimerizarea fibrinei, rezultate in urma actiunii trombinei8<\/sup>.<\/span><\/p>\n

Tromboplastina tisulara este o mixtura de vezicule fosfolipidice si factor tisular. Factorul tisular fiind absent din plasma normala, acesta trebuie furnizat dintr-o sursa externa si astfel cascada reactiilor enzimatice declansate in PT este cunoscuta sub denumirea de \u201ccalea extrinseca\u201d. In mod traditional tromboplastina tisulara era obtinuta din extract de tesut animal (creier, placenta, plaman), dar astazi sunt disponibile mixturi de factor tisular uman recombinant si fosfolipide purificate, care permit prepararea de tromboplastine bine definite, prezentand avantajul lipsei de contaminare cu factori de coagulare (care pot fi gasiti in factorul tisular extras din alte surse), servind astfel cresterii sensibilitatii PT pentru deficientele factorilor de coagulare.6,8<\/sup><\/span><\/p>\n

Cantitatea minima de trombina generata prin activarea de catre factorul tisular a caii extrinseci este suficienta pentru a produce rapid un cheag detectabil in testul pentru PT. Generarea amplificata de trombina asociata cu faza a doua a coagularii nu este necesara pentru a produce un PT normal. Astfel se explica faptul ca deficiente ale factorilor caii intrinseci VIII, IX si XI (precum si ale FXII si FXIII) nu produc prelungirea PT. Coagularea fiziologica necesita faza a doua, exploziva a generarii trombinei, dar formarea cheagului in PT nu7,8<\/sup>.<\/span><\/p>\n

Un PT prelungit indica deficienta unuia sau mai multor factori de coagulare (I, II, V, VII, X) sau prezenta unui inhibitor.8<\/sup><\/span><\/p>\n

Recomandari pentru efectuarea testului<\/em><\/strong> \u00a0<\/strong><\/span><\/p>\n

\u2022 PT este testul cel mai comun utilizat pentru monitorizarea terapiei anticoagulante orale (warfarina), acesta fiind sensibil la trei din cei patru factori de coagulare dependenti de vitamina K;8,9\u00a0<\/em><\/sup><\/span><\/p>\n

\u2022 screeningul deficientelor congenitale sau dobandite ale factorilor II, V, VII, X si fibrinogenului;<\/span><\/p>\n

\u2022 disfibrinogenemii;<\/span><\/p>\n

\u2022 prezenta inhibitorilor fata de factorii de coagulare;<\/span><\/p>\n

\u2022 deficit de vitamina K; <\/span><\/p>\n

\u2022 monitorizarea functiei de sinteza proteica a ficatului;<\/span><\/p>\n

\u2022 screeningul preoperator al hemostazei.<\/span><\/p>\n

Pregatire pacient<\/em><\/strong> - <\/em>\u00e0 jeun (pe nemancate)5<\/sup>.<\/span><\/p>\n

Specimen recoltat<\/em><\/strong> - <\/em>sange venos5<\/sup>.<\/span><\/p>\n

Recipient de recoltare<\/em><\/strong> \u2013 vacutainer cu citrat de Na 0.105M (raport citrat de sodiu \u2013 sange=1\/9).<\/span><\/p>\n

Presiunea realizata de garou trebuie sa fie intre valoarea presiunii sistolice si cea a presiunii diastolice si nu trebuie sa depaseasca 1 minut. Daca punctia venoasa a esuat, o noua tentativa pe aceeasi vena nu se poate face decat dupa 10 minute5<\/sup>.<\/span><\/p>\n

Cantitate recoltata<\/em><\/strong> \u2013 cat permite vacuumul; pentru a preveni coagularea partiala a probei se va asigura amestecul corect al sangelui cu anticoagulantul, prin miscari de inversiune a tubului (5-6 inversiuni blande).5,6<\/sup><\/span><\/p>\n

Cauze de respingere a probei<\/em><\/strong> - <\/em>vacutainer care nu este plin (cel putin 90%); proba hemolizata sau coagulata, proba recoltata in alt tub decat cu citrat .5,6<\/sup><\/span><\/p>\n

Prelucrare necesara dupa recoltare <\/em><\/strong>\u2013 proba va fi centrifugata 15 minute la 2500g5<\/sup>.<\/span><\/p>\n

Stabilitate proba<\/em><\/strong> \u2013 proba este stabila 8 ore <\/em>la temperatura camerei (dupa 8 ore incepe inactivarea factorilor V si VIII); plasma separata este stabila 3 saptamani<\/em> la -20\u00baC; >1 an <\/em>la \u201370\u00baC5<\/sup>. Inaintea analizarii probele congelate trebuie dezghetate rapid in 3-5 min la 37\u00baC. Dezghetarea la temperaturi mai mici poate produce crioprecipitare.6<\/sup><\/span><\/p>\n

Metoda <\/strong>- coagulometrica<\/span>5<\/sup>.<\/span><\/p>\n

Exprimarea rezultatelor<\/em><\/strong>\u00a0<\/em><\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 ca timp de coagulare \u2013 in secunde;<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 ca procent (%) din activitatea normala = activitatea protrombinica (AP); domeniul masurabil = 10-100%;<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 ca raport protrombinic (PR=PT pacient in sec\/PT plasma normala in sec);<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u2013 ca INR (International Normalized Ratio).<\/span><\/p>\n

Numeroase studii internationale au aratat ca in faza stabila a terapiei cu anticoagulante orale (ACO) rezultatele pot varia semnificativ in functie de tesutul de origine a tromboplastinei cat si de instrumentul folosit pentru determinarea acestora. Pentru a rezolva aceasta problema, Organizatia Mondiala a Sanatatii a introdus din 1982 o procedura internationala standardizata de validare a tromboplastinelor. Rezultatele obtinute prin aceasta procedura, in timpul unui tratament anticoagulant stabilizat, nu depind de reactivul folosit. Astfel raportul protrombinic este convertit in INR (International Normalized Ratio) conform formulei:<\/span><\/p>\n

\u00a0\u00a0\u00a0 INR = (PTpacient\/PTplasma normala)^ISI<\/span><\/p>\n

ISI = indice international de sensibilitate (International Sensitivity Index) a tromboplastinei folosite, calculat in raport cu tromboplastina de referinta pentru care ISI=1. Valorile ISI ale tromboplastinelor folosite in lume variaza intre 1 si 3 si sunt stabilite de producatori pentru fiecare lot de reactivi. Cu cat valoarea ISI este mai apropiata de 1, cu atat sensibilitatea reactivului la terapia cu ACO este mai mare.<\/span><\/p>\n

! INR este util numai pentru pacientii cu terapie anticoagulanta orala stabila si nu are nici o valoare pentru diagnosticul sau tratamentul celor cu PT prelungit din alte motive8<\/sup>.<\/span><\/p>\n

INR are acuratete mai mica atunci cand este utilizat la debutul tratamentului cu ACO. Totusi acesta este mai de incredere decat raportul PT neconvertit si se recomanda a fi folosit atat\u00a0 la initierea cat si intimpul tratamentului de intretinere cu ACO1<\/sup>.<\/span><\/p>\n

Reactivul utilizat in Laboratorul Synevo contine o tromboplastina derivata din creier de iepure, cu un ISI=1.2-1.4.<\/span><\/p>\n

Valori de referinta<\/em><\/strong>\u00a0<\/em><\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 - normal<\/span>, activitatea de protrombina > 70%; valorile > 100% nu prezinta semnificatie clinica.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 - interval terapeutic<\/span>:4<\/sup><\/span><\/p>\n

INR=2.0\u20133.0 (2.5): <\/strong>pentru majoritatea situatiilor clinice: profilaxia si tratamentul trombozei venoase; tratamentul embolismului pulmonar; profilaxia emboliei sistemice la pacientii cu fibrilatie atriala, infarct miocardic (daca se asociaza aspirina), boala valvulara mitrala reumatica, prolaps de valva mitrala, calcficare inelara mitrala, trombus mobil de arc aortic, valve cardiace biologice sau proteze mecanice bivalvulare aortice; chirurgia soldului si genunchiului; tromboza de sinus venos; sindrom antifosfolipidic.<\/span><\/p>\n

INR=2.5-3.5 (3.0):<\/strong> valve cardiace mecanice, episoade tromboembolice repetate la pacienti anticoagulati cu INR terapeutic.<\/span><\/p>\n

INR=3.0-4.0<\/strong>\u00a0 (3.5): <\/strong>infarct miocardic, pacienti cu tromboza remisa de proteza valvulara mecanica aortica.<\/span><\/p>\n

INR=3.5-4.5 (4.0):<\/strong> pacienti cu tromboza remisa de proteza valvulara mecanica mitrala.<\/span><\/p>\n

INR=1.5-1.9: <\/strong>pacienti cu un prim episod neprovocat de tromboza venoasa profunda sau embolism pulmonar, dupa primele 3 luni de tratament, in cazul in care nu este posibila testarea INR la interval de 4 saptamani pentru monitorizarea tratamentului; preventia primara a infarctului miocardic la pacienti cu risc crescut1<\/sup>.<\/span><\/p>\n

Tratament anticoagulant-control de laborator<\/em><\/strong><\/span><\/p>\n

Efectul anticoagulant se stabilizeaza la 4-5 zile de la initierea tratamentului. Conform recomandarilor ACCP, monitorizarea PT\/INR trebuie sa inceapa dupa primele 2-3 doze de anticoagulant oral si PT trebuie masurat zilnic pana cand rezultatele PT\/INR se stabilizeaza in intervalul terapeutic. Cand este necesar un efect anticoagulant rapid, heparina sau heparina cu greutate moleculara mica trebuie administrate concomitent, iar suprapunerea cu ACO dureaza pana cand INR a fost in intervalul terapeutic 2 zile consecutiv. Frecventa determinarilor ulterioare este stabilita de catre medic in functie de complianta pacientului si raspunsul la tratament. Dupa obtinerea unei doze stabile se recomanda monitorizarea la un interval nu mai mare de 4 saptamani. Frecventa determinarilor trebuie crescuta de cate ori se introduc sau se intrerup medicamente care ar putea influenta eficienta anticoagularii1<\/sup>.<\/span><\/p>\n

Se recomanda ca o singura metoda de laborator sa fie utilizata pentru monitorizarea tratamentului fiecarui pacient in parte.6<\/sup><\/span><\/p>\n

Valori critice<\/em><\/strong>: INR>6<\/strong> \u2013 risc hemoragic (mai ales la pacientii cu boli gastro-intestinale, HTA, boli renale, cerebro-vasculare, tratament antiagregant, alte medicamente potentiatoare).<\/span><\/p>\n

Interpretarea rezultatelor<\/em><\/strong><\/span><\/p>\n

PT prelungit<\/span> (AP scazuta): tratament cu anticoagulante orale, deficit congenital sau dobandit de factori II, V, VII, X, deficit de vitamina K la nou nascuti, diateze hemoragice la nou nascuti, afectiuni hepatice, obstructie biliara, tulburari de absorbtie intestinala a grasimilor (de ex.: sprue, boala celiaca, diaree cronica), malnutritie, CID, sindrom Zollinger-Ellison, hipofibrinogenemie (fibrinogen <60mg\/dL), disfibrinogenemie, prezenta de anticoagulanti circulanti (inhibitorii specifici fata de factorii caii extrinseci sunt foarte rari), unii pacienti cu anticoagulant lupic cu Ac care leaga si cresc clearence-ul FII, amiloidoza (prin niveluri scazute de FX).6<\/sup><\/span><\/p>\n

Limite si interferente<\/em><\/strong>\u00a0<\/em><\/span><\/p>\n

\u2013\u00a0 Reactivul folosit in laborator nu este influentat de niveluri ale heparinei nefractionate \u22641UI\/mL si de niveluri ale heparinei cu greutate moleculara mica \u22641.5 anti-Xa UI\/mL.5<\/sup><\/span><\/p>\n

\u2013 Calitatea punctiei venoase: manevrele traumatice care duc la eliberarea de tromboplastina tisulara si vacutainerele recoltate insuficient, prin modificarea raportului sange-citrat, au ca rezultat scurtarea PT.<\/span><\/p>\n

\u2013 La valori ale hematocritului peste 55% concentratia plasmatica de citrat este anormal de mare si volumul de anticoagulant\/sange trebuie ajustat luand in considerare alterarea volumului plasmatic.6,9<\/sup> Volumul de sange care trebuie adaugat (la 0.5 mL de citrat 0.109 mol\/L) poate fi calculat conform formulei: [60\/(100 \u2013 hematocrit)] x 4.5.<\/span><\/p>\n

\u2013\u00a0 Mentinerea prelungita a plasmei la 4-8\u00baC poate produce activarea la rece cu cresterea activitatii factorului VII, scurtand PT.<\/span><\/p>\n

\u2013\u00a0 Recoltarea probei pe cateter venos periferic sau central\u00a0 pe care a fost administrata solutie hipertona de NaCl va prelungi PT si APTT (la adulti trebuie indepartati primii 5-10 mL sange pentru a preveni contaminarea sau dilutia cu alte fluide).6<\/sup><\/span><\/p>\n

\u2013\u00a0 Prezenta in proba a produsilor de degradare a fibrinei\u00a0 duce la prelungirea PT.<\/span><\/p>\n

\u2013\u00a0 Nivel crescut de antitrombina sau prezenta anticoagulantilor antitrombinici (hirudin, argatroban) pot prelungi PT. De asemenea anticoagulantii lupici pot afecta PT nereflectand nivelul real de anticoagulare.<\/span><\/p>\n

Acesti pacienti pot fi monitorizati pentru eficacitatea warfarinei cu un test cromogenic pentru FX care nu este afectat de anticoagulantii lupici sau inhibitorii trombinei.6<\/sup><\/span><\/p>\n

\u2013 PT variaza in privinta sensibilitatii la activitatea factorilor de coagulare, fiind mai sensibil la deficiente ale FVII si FX, decat la deficiente ale FII si fibrinogenului.8,9<\/sup><\/span><\/p>\n

\u2013 PT poate sa nu fie sensibil la deficiente usoare ale factorilor de coagulare, acesta fiind de obicei prelungit daca nivelul factorului respectiv este <10% din valoarea normala.6,9<\/sup><\/span><\/p>\n

\u2013 Activitatea FV poate fi cu 10-20% mai mica in specimenele de plasma congelate-dezghetate decat in cele proaspete, chiar in conditii optime de procesare si transport, astfel PT putand fi usor prelungit.8<\/sup><\/span><\/p>\n

\u2013 Plasma congelata transportata pe gheata carbonica in containere inchise poate prezenta o falsa prelungire a PT datorita acidifierii plasmei prin absorbtia de CO2<\/sub>; expunerea plasmei dezghetate la aerul atmosferic pentru cateva minute de obicei elimina acest efect.8<\/sup><\/span><\/p>\n

\u2022 Medicamente si alti factori de influenta:<\/span><\/p>\n

In tabel sunt mentionate medicamente si alimente care interfera cu warfarina clasificate dupa nivelul dovezilor sustinatoare si dupa directia de interactiune (dupa Holbrook s.a.).1<\/sup><\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Nivel de <\/strong>influenta<\/strong>\u00a0<\/strong><\/span><\/p>\n<\/td>\n

Antiinfecti<\/strong>oase<\/strong><\/span><\/td>\n\n

Cardiovas<\/strong>culare<\/strong><\/span><\/p>\n<\/td>\n

\n

Analgezice,<\/strong><\/span><\/p>\n

antiinflama<\/strong>toare,<\/strong><\/span><\/p>\n

\u00a0imu<\/strong>nomodula<\/strong>toare<\/strong><\/span><\/td>\n

\n

Medica<\/strong>mente SNC<\/strong><\/span><\/p>\n<\/td>\n

\n

Medica<\/strong>mente GI <\/strong>si alimente<\/strong><\/span><\/p>\n<\/td>\n

\n

Alte medica<\/strong>mente<\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Potentia<\/span><\/em><\/strong>toare<\/span><\/em><\/strong><\/span><\/p>\n

Foarte pro<\/em>babile<\/em><\/span><\/p>\n<\/td>\n

\n

Ciprofloxacin<\/span><\/p>\n

Cotrimoxazol<\/span><\/p>\n

Eritromicina<\/span><\/p>\n

Fluconazol<\/span><\/p>\n

Izoniazida<\/span><\/p>\n

Metronidazol<\/span><\/p>\n

Miconazol<\/span><\/p>\n

(incl. sup.<\/span><\/p>\n

vag.)<\/span><\/p>\n

Voriconazol<\/span><\/p>\n<\/td>\n

\n

Amiodarona<\/span><\/p>\n

Clofibrat<\/span><\/p>\n

Diltiazem<\/span><\/p>\n

Fenofibrat<\/span><\/p>\n

Propafenona<\/span><\/p>\n

Propranolol<\/span><\/p>\n

Sulfinpirazona<\/span><\/p>\n<\/td>\n

\n

Fenilbutazona<\/span><\/p>\n

Piroxicam<\/span><\/p>\n<\/td>\n

\n

Alcool (daca<\/span><\/p>\n

exista boala<\/span><\/p>\n

hepatica<\/span><\/p>\n

concomitenta)<\/span><\/p>\n

Citalopram<\/span><\/p>\n

Entacapona<\/span><\/p>\n

Sertralin<\/span><\/p>\n<\/td>\n

\n

Cimetidina<\/span><\/p>\n

Ulei de peste<\/span><\/p>\n

Mango<\/span><\/p>\n

Omeprazol<\/span><\/p>\n<\/td>\n

\n

Steroizi<\/span><\/p>\n

anabolizanti<\/span><\/p>\n

Zileuton<\/span><\/p>\n

\u00a0<\/span><\/td>\n<\/tr>\n

\n

Probabile<\/em><\/span><\/p>\n<\/td>\n

\n

Amozicilina\/<\/span><\/p>\n

clavulanat<\/span><\/p>\n

Azitromicina<\/span><\/p>\n

Claritromicina<\/span><\/p>\n

Itraconazol<\/span><\/p>\n

Levofloxacin<\/span><\/p>\n

Ritonavir<\/span><\/p>\n

Tetraciclina<\/span><\/p>\n<\/td>\n

\n

Aspirina<\/span><\/p>\n

Fluvastatin<\/span><\/p>\n

Chinidina<\/span><\/p>\n

Ropinirol<\/span><\/p>\n

Simvastatin<\/span><\/p>\n<\/td>\n

\n

Acetaminofen<\/span><\/p>\n

Aspirina<\/span><\/p>\n

Celecoxib<\/span><\/p>\n

Dextropropoxifen<\/span><\/p>\n

Interferon<\/span><\/p>\n

Tramadol<\/span><\/p>\n<\/td>\n

\n

Disulfiram<\/span><\/p>\n

Cloral hidrat<\/span><\/p>\n

Fluvoxamin<\/span><\/p>\n

Fenitoin (bifazic cu inhibitie tardiva)<\/span><\/p>\n<\/td>\n

\n

Grapefruit<\/span><\/p>\n<\/td>\n

\n

Fluorouracil<\/span><\/p>\n

Gemcitabina<\/span><\/p>\n

Levamisol\/<\/span><\/p>\n

fluorouracil<\/span><\/p>\n

Paclitaxel<\/span><\/p>\n

Tamoxifen<\/span><\/p>\n

Tolterodin<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Posibile<\/em><\/span><\/p>\n<\/td>\n

\n

Amoxicilina<\/span><\/p>\n

Cloramfenicol<\/span><\/p>\n

Gatifloxacin<\/span><\/p>\n

Miconazol<\/span><\/p>\n

(gel local)<\/span><\/p>\n

Acid nalidixic<\/span><\/p>\n

Norfloxacin<\/span><\/p>\n

Ofloxacin<\/span><\/p>\n

Saquinavir<\/span><\/p>\n

Terbinafina<\/span><\/p>\n<\/td>\n

\n

Disopiramida<\/span><\/p>\n

Gemfibrozil<\/span><\/p>\n

Metolazona<\/span><\/p>\n<\/td>\n

\n

Celecoxib<\/span><\/p>\n

Indometacin<\/span><\/p>\n

\u041b\u0435\u0444\u043b\u0443\u043d\u043e\u043c\u0438\u0434<\/span><\/p>\n

Propoxifen<\/span><\/p>\n

Rofecoxib<\/span><\/p>\n

Sulindac<\/span><\/p>\n

Tolmetin<\/span><\/p>\n

Salicilati topic<\/span><\/p>\n<\/td>\n

\n

Felbamat<\/span><\/p>\n<\/td>\n

\n

Orlistat<\/span><\/p>\n<\/td>\n

\n

Acarboza<\/span><\/p>\n

Ciclofosfamida\/<\/span><\/p>\n

metotrexat\/<\/span><\/p>\n

fluorouracil<\/span><\/p>\n

Curbicin<\/span><\/p>\n

Danazol<\/span><\/p>\n

Ifosfamida<\/span><\/p>\n

Trastuzumab<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Foarte im<\/em>probabile<\/em><\/span><\/p>\n<\/td>\n

\n

Cefamandol<\/span><\/p>\n

Cefazolin<\/span><\/p>\n

Sulfisoxazol<\/span><\/p>\n<\/td>\n

\n

Bezafibrat<\/span><\/p>\n

Heparina<\/span><\/p>\n<\/td>\n

\n

Levamisol<\/span><\/p>\n

Metilprednisolon<\/span><\/p>\n

Nabumetona<\/span><\/p>\n<\/td>\n

\n

Fluoxetin\/<\/span><\/p>\n

diazepam<\/span><\/p>\n

Quetiapin<\/span><\/p>\n<\/td>\n

\u00a0<\/span><\/td>\n\n

Etopozid\/<\/span><\/p>\n

carboplatin<\/span><\/p>\n

Levonorgestrel<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Inhibitoare<\/span><\/em><\/strong><\/span><\/p>\n

Foarte pro<\/em>babile<\/em><\/span><\/p>\n<\/td>\n

\n

Griseofulvina<\/span><\/p>\n

Nafcilina<\/span><\/p>\n

Ribavirina<\/span><\/p>\n

Rifampicina<\/span><\/p>\n<\/td>\n

\n

Colestiramina<\/span><\/p>\n<\/td>\n

\n

Mesalamina<\/span><\/p>\n<\/td>\n

\n

Barbiturice<\/span><\/p>\n

\u041a\u0430\u0440\u0431\u0430\u043c\u0430\u0437\u0435\u043f\u0438\u043d<\/span><\/p>\n<\/td>\n

\n

Alimente cu<\/span><\/p>\n

continut cres-<\/span><\/p>\n

cut de vitami-<\/span><\/p>\n

na K (legume<\/span><\/p>\n

verzi)\/nutritie<\/span><\/p>\n

enterala<\/span><\/p>\n

Avocado<\/span><\/p>\n

(cantitati<\/span><\/p>\n

mari)<\/span><\/p>\n<\/td>\n

\n

Mercaptopurina<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Probabile<\/em><\/span><\/p>\n<\/td>\n

\n

Dicloxacilina<\/span><\/p>\n

Ritonavir<\/span><\/p>\n<\/td>\n

\n

Bosentan<\/span><\/p>\n<\/td>\n

\n

Azatioprina<\/span><\/p>\n<\/td>\n

\n

Cloradiazepozid<\/span><\/p>\n<\/td>\n

\n

Lapte de soia<\/span><\/p>\n

Sucralfat<\/span><\/p>\n<\/td>\n

\n

Terapie<\/span><\/p>\n

chelatoare<\/span><\/p>\n

Vaccin<\/span><\/p>\n

antigripal<\/span><\/p>\n

Suplimente<\/span><\/p>\n

multivitaminice<\/span><\/p>\n

Raloxifen<\/span><\/p>\n

HCL<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Posibile<\/em><\/span><\/p>\n<\/td>\n

\n

Terbinafina<\/span><\/p>\n<\/td>\n

\n

Telmisatran<\/span><\/p>\n<\/td>\n

\n

Sulfasalazina<\/span><\/p>\n<\/td>\n

\u00a0<\/span><\/td>\n\n

Sushi cu fructe de mare<\/span><\/p>\n<\/td>\n

\n

Ciclosporina<\/span><\/p>\n

Etetrinat<\/span><\/p>\n

Ubidicaremon<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Foarte im<\/em>probabile<\/em><\/span><\/p>\n<\/td>\n

\n

Cloxacilina<\/span><\/p>\n

Natcilina\/<\/span><\/p>\n

dicloxacilina<\/span><\/p>\n

Teicoplanina<\/span><\/p>\n<\/td>\n

\n

Furosemid<\/span><\/p>\n<\/td>\n

\u00a0<\/span><\/td>\n\n

Propofol<\/span><\/p>\n<\/td>\n

\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0<\/span><\/p>\n

Alte medicamente potentiatoare: cefalosporine de generatia a doua si a treia, hormoni tiroidieni, salicilati >1.5 g\/zi, sulfonamide.1<\/sup><\/span><\/p>\n

! <\/strong>Efectul de potentare este mai accentuat la varstnici, in cazuri de malnutritie, malabsortie, cancer, febra, hipertiroidie, boli hepatice, biliare, insuficienta cardiaca congestiva, consumul de alcool pe termen lung.<\/span><\/p>\n

Conditiile asociate cu deshidratare, hipotiroidie, sindrom nefrotic favorizeaza efectul antagonist<\/span>.<\/p>\n

\u00a0<\/span>\u00a0<\/span>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n

1. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G, \u201cPharmacology and Management of the Vitamin K Antagonists-American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)\u201d, Chest, 2008, 133:160S-198S<\/span><\/p>\n

2. Dati F, Wagner C. \u201cHemostasis\u201d, Lothar Thomas` Clinical Laboratory Diagnostics, first edition, Frankfurt, Germany, 1998, 599-602.<\/span><\/p>\n

3. Fischbach F. \u201cBlood Studies. Hematology and Coagulation\u201d, A Manual of Laboratory and Diagnostic Test, 7th ed, Philadelphia, 2004, 164-167.<\/span><\/p>","protected":false},"excerpt":{"rendered":"

\u0421\u043a\u0440\u0438\u043d\u0438\u043d\u0433\u043e\u0432\u044b\u0439 \u0430\u043d\u0430\u043b\u0438\u0437 \u0434\u043b\u044f \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u044f \u0434\u0435\u0444\u0438\u0446\u0438\u0442\u0430 \u043e\u0434\u043d\u043e\u0433\u043e \u0438\u043b\u0438 \u043d\u0435\u0441\u043a\u043e\u043b\u044c\u043a\u0438\u0445 \u0444\u0430\u043a\u0442\u043e\u0440\u043e\u0432 \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u0432\u043d\u0435\u0448\u043d\u0435\u0439 \u0441\u0438\u0441\u0442\u0435\u043c\u044b \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u043a\u0440\u043e\u0432\u0438 (I, II, V, VII, X) \u0438\u0437-\u0437\u0430 \u043d\u0430\u0441\u043b\u0435\u0434\u0441\u0442\u0432\u0435\u043d\u043d\u043e\u0433\u043e \u0434\u0435\u0444\u0438\u0446\u0438\u0442\u0430 \u0438\u043b\u0438 \u043f\u0440\u0438\u043e\u0431\u0440\u0435\u0442\u0435\u043d\u043d\u044b\u0445 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u0439, \u0442\u0430\u043a\u0438\u0445 \u043a\u0430\u043a \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u043f\u0435\u0447\u0435\u043d\u0438, \u0434\u0435\u0444\u0438\u0446\u0438\u0442 \u0432\u0438\u0442\u0430\u043c\u0438\u043d\u0430 \u041a \u0438\u043b\u0438 \u0438\u043d\u0433\u0438\u0431\u0438\u0442\u043e\u0440\u0430 \u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u0444\u0430\u043a\u0442\u043e\u0440\u0430. \u0418\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0434\u043b\u044f \u043c\u043e\u043d\u0438\u0442\u043e\u0440\u0438\u043d\u0433\u0430 \u043f\u0435\u0440\u043e\u0440\u0430\u043b\u044c\u043d\u043e\u0439 \u0430\u043d\u0442\u0438\u043a\u043e\u0430\u0433\u0443\u043b\u044f\u043d\u0442\u043d\u043e\u0439 \u0442\u0435\u0440\u0430\u043f\u0438\u0438, \u0447\u0442\u043e\u0431\u044b \u043f\u043e\u0434\u0434\u0435\u0440\u0436\u0438\u0432\u0430\u0442\u044c \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u0432 \u0431\u0435\u0437\u043e\u043f\u0430\u0441\u043d\u043e\u043c \u0442\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u043c \u0434\u0438\u0430\u043f\u0430\u0437\u043e\u043d\u0435.<\/p>\n

\u041f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d \u2014 \u0441\u043b\u043e\u0436\u043d\u044b\u0439 \u0431\u0435\u043b\u043e\u043a, \u043a\u043e\u0442\u043e\u0440\u044b\u0439 \u043e\u0442\u043e\u0431\u0440\u0430\u0436\u0430\u0435\u0442 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u0435 \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u044e\u0449\u0435\u0439 \u0441\u0438\u0441\u0442\u0435\u043c\u044b \u043a\u0440\u043e\u0432\u0438, \u043e\u0434\u043d\u0438 \u0438\u0437 \u0432\u0430\u0436\u043d\u0435\u0439\u0448\u0438\u0445 \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u0435\u0439 \u043a\u043e\u0430\u0433\u0443\u043b\u043e\u0433\u0440\u0430\u043c\u043c\u044b.<\/p>\n

\u041f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u043e\u0432\u043e\u0435 \u0432\u0440\u0435\u043c\u044f (\u041f\u0422\u0412) \u2014 \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u044c \u0441\u0438\u0441\u0442\u0435\u043c\u044b \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u043a\u0440\u043e\u0432\u0438, \u043e\u0442\u0440\u0430\u0436\u0430\u044e\u0449\u0438\u0439 \u0432\u0440\u0435\u043c\u044f \u0441\u0432\u0451\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u043a\u0440\u043e\u0432\u0438.<\/p>\n

\u041f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u043e\u0432\u043e\u0435 \u0432\u0440\u0435\u043c\u044f \u043e\u0442\u0440\u0430\u0436\u0430\u0435\u0442 \u0432\u0440\u0435\u043c\u044f \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u043f\u043b\u0430\u0437\u043c\u044b \u043f\u043e\u0441\u043b\u0435 \u0434\u043e\u0431\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u0442\u0440\u043e\u043c\u0431\u043e\u043f\u043b\u0430\u0441\u0442\u0438\u043d-\u043a\u0430\u043b\u044c\u0446\u0438\u0435\u0432\u043e\u0439 \u0441\u043c\u0435\u0441\u0438. \u0422\u0430\u043a\u043e\u0435 \u043f\u0440\u0435\u0434\u0441\u0442\u0430\u0432\u043b\u0435\u043d\u0438\u0435 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0430 \u043f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u043e\u0432\u043e\u0433\u043e \u0442\u0435\u0441\u0442\u0430 \u043d\u0435 \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u0435\u0442 \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u0442\u044c \u0441\u0440\u0430\u0432\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u0443\u044e \u043e\u0446\u0435\u043d\u043a\u0443 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u043e\u0432, \u043f\u043e\u0441\u043a\u043e\u043b\u044c\u043a\u0443 \u0440\u0430\u0437\u043d\u044b\u0435 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0438\u0438 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u044e\u0442 \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u0435 \u043c\u0435\u0442\u043e\u0434\u044b \u0438 \u0430\u043f\u043f\u0430\u0440\u0430\u0442\u0443\u0440\u0443, \u0430 \u0433\u043b\u0430\u0432\u043d\u043e\u0435 \u2014 \u0442\u0440\u043e\u043c\u0431\u043e\u043f\u043b\u0430\u0441\u0442\u0438\u043d \u0440\u0430\u0437\u043d\u043e\u0439 \u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u0438 \u0438 \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u043e\u0433\u043e \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0436\u0434\u0435\u043d\u0438\u044f.<\/p>\n

\u0412\u0441\u0435\u043c\u0438\u0440\u043d\u0430\u044f \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u0430\u0446\u0438\u044f \u0437\u0434\u0440\u0430\u0432\u043e\u043e\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u044f (\u0412\u041e\u0417) \u0440\u0430\u0437\u0440\u0430\u0431\u043e\u0442\u0430\u043b\u0430 \u0438 \u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u043e\u0432\u0430\u043b \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u0442\u044c \u041c\u041d\u041e (\u043c\u0435\u0436\u0434\u0443\u043d\u0430\u0440\u043e\u0434\u043d\u043e\u0435 \u043d\u043e\u0440\u043c\u0430\u043b\u0438\u0437\u043e\u0432\u0430\u043d\u043d\u043e\u0435 \u043e\u0442\u043d\u043e\u0448\u0435\u043d\u0438\u0435, \u0440\u0430\u0441\u0441\u0447\u0438\u0442\u0430\u043d\u043d\u043e\u0435 \u043d\u0430 \u043e\u0441\u043d\u043e\u0432\u0435 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u043e\u0432 \u043f\u043e\u043b\u0443\u0447\u0435\u043d\u043d\u043e\u0433\u043e \u043f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u043e\u0432\u043e\u0433\u043e \u0432\u0440\u0435\u043c\u0435\u043d\u0438).<\/p>\n

\u041f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d \u043f\u043e \u041a\u0432\u0438\u043a\u0443 \u2013 \u043e\u0442\u0440\u0430\u0436\u0430\u0435\u0442 \u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c \u043f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u0430 \u0432 %, \u0440\u0430\u0441\u0441\u0447\u0438\u0442\u0430\u043d\u043d\u0443\u044e \u043f\u043e \u043a\u0430\u043b\u0438\u0431\u0440\u043e\u0432\u043e\u0447\u043d\u043e\u043c\u0443 \u0433\u0440\u0430\u0444\u0438\u043a\u0443, \u044d\u0442\u043e\u0442 \u043f\u0430\u0440\u0430\u043c\u0435\u0442\u0440 \u0432 \u0445\u043e\u043d\u0435 \u043d\u043e\u0440\u043c\u0430\u043b\u044c\u043d\u044b\u0445 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0439 \u043d\u0435\u0440\u0435\u0434\u043a\u043e \u0441\u043e\u0432\u043f\u0430\u0434\u0430\u0435\u0442 \u0441 \u043f\u0440\u043e\u0442\u0440\u043e\u043c\u0431\u0438\u043d\u043e\u0432\u044b\u043c \u0438\u043d\u0434\u0435\u043a\u0441\u043e\u043c.<\/p>\n

\u041f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u0435 \u0434\u043b\u044f \u043f\u0440\u043e\u0432\u0435\u0434\u0435\u043d\u0438\u044f \u0430\u043d\u0430\u043b\u0438\u0437\u0430:<\/p>\n

    \n
  • \u0434\u043b\u044f \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u044f \u0433\u0435\u043c\u043e\u0441\u0442\u0430\u0437\u0430 \u043f\u0440\u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u0438 \u043f\u0440\u043e\u0442\u0438\u0432\u043e\u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u044e\u0449\u0438\u043c\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430\u043c\u0438 (\u0432\u0430\u0440\u0444\u0430\u0440\u0438\u043d, \u0444\u0435\u043d\u0438\u043b\u0438\u043d, \u0441\u0438\u043d\u043a\u0443\u043c\u0430\u0440 \u0438 \u0434\u0440.);<\/li>\n
  • \u0434\u043b\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u0439, \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0438\u0437\u0443\u044e\u0449\u0438\u0445\u0441\u044f \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u043d\u044b\u043c \u0440\u0438\u0441\u043a\u043e\u043c \u0442\u0440\u043e\u043c\u0431\u043e\u043e\u0431\u0440\u0430\u0437\u043e\u0432\u0430\u043d\u0438\u044f.<\/li>\n<\/ul>\n

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