Haram: Hormon Babi Dalam Ubat Sakit Jantung !

RoyMakaay

Reply  maximus_01


lagi lambat bagi, lagi la risko mati/cardiac arrest.....nak buat camner kalau ko jadi doctor kat A&E?? nak kata kat nurse....patient ni Islam...boleh telefon farmasi, bawak mai ubat arixtra?....tu berapa jam baru sampai agak2?.....tu kalau siang...kalau malam/weekends...farmasi tutup?? haaa...tak ka naya...

kalau arixtra ni murah, senang dapat, ada kat semua department macam clexane ni ok laa...

nak taknak, bila dah doktor ni, macam2 dilema kena handle...etika, agama etc....
ghettoVet Post at 14-5-2011 14:26

Kalau ikutkan harga, kat tempat aku ni Arixtra lagi murah dari Clexane.

Fondaparinux Sodium 2.5mg/0.5ml Inj RM19.69/vial,
Enoxaparin Na 40mg/0.4ml Inj RM19.79/vial
Enoxaparin Na 60mg/0.6ml Inj RM24.05/vial.

Bergantung pada department masing2 untuk beli yang mana satu. Mungkin kau boleh suggestkan kepada pihak farmasi untuk bekalkan Fondaparinux untuk A&E as a floor stock. Tak ada masalah tu aku rasa.

RoyMakaay

Aku pun sependapat dengan kau. Aku tak sure samada current CPG kata Arixtra ni sesuai dalam kes acute coronary syndrome. Memang sejak dulu sampai last ake keja spital, guna clexane aja....
RedDevils Post at 14-5-2011 15:43

Dalam CPG (UA/NSTEMI 2002 & STEMI 2007) memang ada cakap yang Arixtra indicated juga untuk ACS. Memang studies ada yang cakap Arixtra comparable to Clexane, in fact better than Clexane in reducing bleeding event.

Ni antara study yang melibatkan Fondaparinux vs Enoxa

1) OASIS-5
Fondaparinux in acute coronary syndromes without ST elevations is comparable with enoxaparin in preventing ischemic events, is associated with fewer bleedings than enoxaparin, and is associated with a lower mid-term mortality.

In patients with NSTE ACS, fondaparinux was not inferior to enoxaparin in reducing the occurrence of death, MI or refractory ischemia at 9 days, and was superior to enoxaparin in reducing death and stroke at 30 days.

Fondaparinux significantly reduced major bleeding throughout the study. The occurrence of major bleeding was associated with a higher mortality independent of the presence of other adverse risk markers, and the substantial reduction in major bleeding produced by fondaparinux translated into a survival advantage that remained evident at 6 months.

In patients with STEMI who were not treated with primary PCI, fondaparinux significantly reduced death and MI without increasing bleeding. Fondaparinux was associated with a mortality advantage throughout the study. High-risk STEMI patients appeared to benefit most from fondaparinux treatment.

The findings from OASIS 5 and 6 indicate that the balance of benefit and risk of fondaparinux is better than enoxaparin for patients with non-ST elevation ACS and better than usual treatment for patients with STEMI who are not treated with primary PCI.

Further readings,
1) http://www.medscape.com/viewarticle/590179
2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2293968/
3) http://www.ncbi.nlm.nih.gov/pubmed/20152216

RoyMakaay

in certain case/indication, there's no option whether to use clexane or arixtra. cuma bole guna clexane je. klau nk example nnt nk kena bukak buku dulu. dulu penah cari jugak pasal isu ni sbb nk patient muslim sume guna arixtra instead of clexane.

but still, x semua hospital ada arixtra (nama sebenar, fondaparinux)
saki_kawaii Post at 14-5-2011 19:05

Bagi patient choice untuk pilih yang mana satu. Explain kepada mereka pasal kedua-dua ubat ni (Kalau hospital tu ada Arixtra la). Pendapat aku memang sepatutnya bagi Arixtra la since dah ada alternatif untuk Clexane (yang mana keberkesanan dia comparable dengan Clexane). Unless patient punya renal tak ok (ClCr < 30ml/min) & nak buat emergency procedure / op etc (since half-life Arixtra is much longer than Clexane)

ghettoVet

baguslah kalau arixtra ader kat hospital readily...kalau betul lg murah, lagi bagus...

tapi still injection kan?...byk problem injection ni...lipohypertrophy la, subcutaneous haematoma, cellulitis bla2...

kita tunggu Xarelto kluar....Xarelto ni ubat pil jerr....tgh final stage Phase III clinical trial dgr kata....

kluar xarelto, lesen jer...abisla clexane/arixtra sumer ni tak laku...dier tak affect platelet count macam clexane/arixtra...

mbhcsf

baguslah kalau arixtra ader kat hospital readily...kalau betul lg murah, lagi bagus...

tapi still ...
ghettoVet Post at 15-5-2011 05:03

    wow cool man..ni berita yang hampir agak baik i see dah ada bentuk pil dah ye

RoyMakaay

baguslah kalau arixtra ader kat hospital readily...kalau betul lg murah, lagi bagus...

tapi still injection kan?...byk problem injection ni...lipohypertrophy la, subcutaneous haematoma, cellulitis bla2...

kita tunggu Xarelto kluar....Xarelto ni ubat pil jerr....tgh final stage Phase III clinical trial dgr kata....

kluar xarelto, lesen jer...abisla clexane/arixtra sumer ni tak laku...dier tak affect platelet count macam clexane/arixtra...
ghettoVet Post at 15-5-2011 05:03

Ya.. Untuk oral, kita ada Dabigatran (Pradaxa). Indication dalam MOH Formulary kalau tak silap VTE Prevention after hip/knee replacement surgery. Cuma yang problemnya sekarang, ubat baru --> Harga. Sebiji capsule pun aku rasa dalam RM12 juga tu. Once dah ada generic dabigatran, memang selamat tinggal la warfarin.

ghettoVet

Ya.. Untuk oral, kita ada Dabigatran (Pradaxa). Indication dalam MOH Formulary kalau tak silap VTE Prevention after hip/knee replacement surgery. Cuma yang problemnya sekarang, ubat baru --> Harga. Sebiji capsule pun aku rasa dalam RM12 juga tu. Once dah ada generic dabigatran, memang selamat tinggal la warfarin..
RoyMakaay Post at 15-5-2011 10:47

tapi Pradaxa ni thrombin inhibitor...which is like warfarin, mostly inhibit extrinsic pathway of the coagulation cascade....untuk VTE, post surgery elokla....

but for acute coronary syndrome- which is mainly caused by fibrin/platelets and intrinsic pathway (arterial system)....kena guna dual antiplatelet therapy jugak plus anticoagulant that's active in inhibiting intrinsic pathway (e.g. clexane).

xarelto nanti akan jadi superior sebab dier adalah specific factor Xa inhibitor....which we all know factor Xa ni, is involved in both intrinsic and extrinsic pathway.......(kalau salah tolong betulkan eh Dr Reddevil...aku pun ingat2 lupa dah)

so xarelto will be good for both venous system and arterial system clot prevention....