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\/\/www.afterroberto.com\/wp-content\/uploads\/2017\/07\/M70515g.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】凝血，是身體自我保護的機制，防止傷口流血不止。但當在沒有創傷情况下，血管內形成血塊，就會構成危險，病人需要服用抗血栓藥。抗血栓藥分兩大類：抗凝血藥和抗血小板藥。<\/p>\n

郭：郭業東醫生 董：董光達醫生<\/p>\n

郭﹕抗血栓藥分兩種，抗血小板藥和抗凝血藥。抗血小板藥包括阿士匹靈（aspirin）及氯比格雷（clopidogrel）；而常見的抗凝血藥有華法林及新型口服抗凝血藥物。兩種抗血栓藥有何分別？<\/p>\n

董﹕血小板是止血的第一道防線，當血管內壁受損時，血小板聚集在受損位置，形成血塊，減少失血。抗血小板藥令血小板的黏性下降，減少血管內形成血塊，主要用於動脈疾病。例如：中風病人因血管內斑塊破損，血小板聚集成血塊，阻塞血管；或冠心病的血管出現血塊，造成心肌梗塞而心臟病發。<\/p>\n

抗凝血藥主要是減低凝血因子的功效，用於血液流動較慢的血管，包括靜脈、心房，減低血塊形成，常用於深層靜脈血管閉塞或心房纖顫等病人身上。<\/p>\n

薄血藥防血塊 誰人需服用？<\/p>\n

郭﹕門診常接觸到心房顫動的病人，他們大都要服用抗凝血藥。除了心房顫動，還有什麼病人需要服用抗凝血藥？<\/p>\n

董﹕不少病人需要服用抗凝血藥，例如曾接受心瓣手術的病人，需要長期服用抗凝血藥，以減少心瓣上形成血塊，出現心瓣栓塞或中風等併發症的風險。曾經患上靜脈血管閉塞，或稱經濟艙綜合症的病人，他們身體長時間處於少活動的環境，例如坐長途飛機、大手術後臥牀等，雙腳容易形成血塊；一旦曾出現這個情况，便需要處方抗凝血藥，減少血塊出現的風險。此外，曾經患有肺動脈血管閉塞病人，都需要用到抗凝血藥，減低肺栓塞，導致心室衰竭等併發症。<\/p>\n

預防中風 新藥勝舊藥<\/p>\n

郭﹕現在有四類抗凝血藥，包括傳統的華法林，以及較新的達比加群酯（dabigatran etexilate）、利伐沙班（rivaroxaban）、阿哌沙班（apixaban）。傳統藥物與新抗凝血藥有何分別？<\/p>\n

董﹕傳統華法林，必須要將劑量控制得相當精準，加上易受食物或其他藥物影響令藥效改變，所以服用病人需要較頻密覆診和抽血，以調校華法林的劑量和藥效。<\/p>\n

新型的抗凝血藥，好處是較少與其他食物或藥物相互影響。另外，亦有不同研究顯示，在相同副作用風險下，新藥預防中風的功效，較傳統華法林優勝；或在相同預防中風功效下，新藥出現出血風險較低。<\/p>\n

不同手術 停藥時間各異<\/p>\n

郭﹕服用抗凝血藥，最擔心是有出血或流血不止，若病人需要接受手術，如：照大腸鏡或牙科治療，需要注意什麼？<\/p>\n

董﹕服用抗凝血藥的病人，一旦受傷出血時，出血量會較常人為多，但只要按壓傷口時間夠長，一般都能夠止血。若不幸無法止血，便需要盡快求醫，醫生會判斷是否需要停藥，或利用其他藥物減低抗凝血藥的功效。<\/p>\n

而病人需要接受入侵性治療或檢查時，治療前緊記告訴醫生或牙醫，正在服用抗凝血藥，因為不同病人在不同情况下，停藥時間不同。例如：接受腸鏡兼切除瘜肉手術，服用華法林的病人需要停藥三日，而新型抗凝血藥則要停藥一至兩日。但每個個案考慮因素都不同，需視乎病人出血風險及血管血塊形成的風險而定。手術後，亦需要與醫生討論何時重新服用抗凝血藥。<\/p>\n

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