{"id":53763,"date":"2023-09-20T09:50:27","date_gmt":"2023-09-20T09:50:27","guid":{"rendered":"https:\/\/medsname.com\/uniwarfin\/"},"modified":"2026-05-01T10:49:12","modified_gmt":"2026-05-01T10:49:12","slug":"uniwarfin","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/uniwarfin\/","title":{"rendered":"Uniwarfin"},"content":{"rendered":"


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\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Co je Uniwarfin?<\/h3>\n

Uniwarfin<\/strong> je 5 mg tablety warfarinu od Unichem \u2014 peror\u00e1ln\u00ed antikoagulant ze skupiny antagonist\u016f vitaminu K (VKA). Warfarin byl poprv\u00e9 syntetizov\u00e1n z dikumarolu ve 40. letech 20. stolet\u00ed a schv\u00e1len jako l\u00e9k pro \u010dlov\u011bka v roce 1954; navzdory n\u00e1stupu DOAC z\u016fst\u00e1v\u00e1 l\u00e9kem prvn\u00ed volby u mechanick\u00fdch srde\u010dn\u00edch chlopn\u00ed, st\u0159edn\u011b t\u011b\u017ek\u00e9 a\u017e t\u011b\u017ek\u00e9 mitr\u00e1ln\u00ed sten\u00f3zy a antifosfolipidov\u00e9ho syndromu. Mechanismus: blokuje vitamin K epoxid redukt\u00e1zu (VKORC1), \u010d\u00edm\u017e sni\u017euje hladinu aktivn\u00edch forem koagula\u010dn\u00edch faktor\u016f II, VII, IX, X a protein\u016f C a S. N\u00e1stup \u00fa\u010dinku je opo\u017ed\u011bn o 3-5 dn\u00ed, proto\u017ee cirkuluj\u00edc\u00ed faktory mus\u00ed nejprve vymizet. D\u00e1vkov\u00e1n\u00ed je vysoce individualizovan\u00e9 a \u0159\u00edzen\u00e9 INR \u2014 c\u00edlov\u00e9 INR je 2,0-3,0 u v\u011bt\u0161iny indikac\u00ed, 2,5-3,5 u mechanick\u00fdch mitr\u00e1ln\u00edch nebo star\u0161\u00edch aort\u00e1ln\u00edch prot\u00e9z. Denn\u00ed p\u0159\u00edjem vitaminu K (zelenina) by m\u011bl b\u00fdt konzistentn\u00ed, nikoli se mu vyh\u00fdbat. Hlavn\u00ed krv\u00e1cen\u00ed se vyskytuje u ~1-3 % pacient\u016f\/rok p\u0159i terapeutick\u00e9 hladin\u011b warfarinu. Reverze: peror\u00e1ln\u00ed nebo intraven\u00f3zn\u00ed vitamin K plus \u010dty\u0159faktorov\u00fd protrombinov\u00fd komplexn\u00ed koncentr\u00e1t p\u0159i z\u00e1va\u017en\u00e9m krv\u00e1cen\u00ed. Standardem je dohled specialisty nebo praktick\u00e9ho l\u00e9ka\u0159e.<\/p>\n<\/div>\n

\nCo z\u00edsk\u00e1te s MedsBase:<\/strong> V\u00fdrobce certifikovan\u00fd WHO-GMP \u00b7 Diskr\u00e9tn\u00ed balen\u00ed \u00b7 Celosv\u011btov\u00e1 doprava \u00b7 V\u00edce ne\u017e 1 400 ov\u011b\u0159en\u00fdch recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/div>\n

\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/strong><\/a> \u2014 pokud va\u0161e z\u00e1silka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, p\u0159epos\u00edl\u00e1me ji.<\/p>\n

Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n

Na\u0161e generick\u00e9 l\u00e9ky poch\u00e1zej\u00ed od v\u00fdrobc\u016f certifikovan\u00fdch WHO-GMP a jsou expedov\u00e1ny po cel\u00e9m sv\u011bt\u011b v diskr\u00e9tn\u00edm, nen\u00e1padn\u00e9m balen\u00ed \u2013 na vn\u011bj\u0161\u00ed stran\u011b bal\u00edku nen\u00ed uveden n\u00e1zev l\u00e9ku. Platby kartou jsou sm\u011brov\u00e1ny prost\u0159ednictv\u00edm regulovan\u00e9ho procesoru (popisky na v\u00fdpisu zahrnuj\u00ed regulovan\u00e9ho procesora plateb kartou \u2013 nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku). P\u0159ij\u00edm\u00e1me tak\u00e9 kryptom\u011bny a bankovn\u00ed p\u0159evody SEPA. Ka\u017ed\u00e1 objedn\u00e1vka je zaji\u0161t\u011bna na\u0161\u00ed politikou p\u0159eposl\u00e1n\u00ed.<\/p>\n

Co je Uniwarfin?<\/h2>\n

Uniwarfin jsou 5 mg tablety warfarinu sodn\u00e9ho od Unichem, dod\u00e1van\u00e9 v balen\u00ed po 30-90 tablet\u00e1ch. Warfarin je nejpou\u017e\u00edvan\u011bj\u0161\u00edm peror\u00e1ln\u00edm antikoagulantem na sv\u011bt\u011b. Navzdory zaveden\u00ed p\u0159\u00edm\u00fdch peror\u00e1ln\u00edch antikoagulanci\u00ed (DOAC) z\u016fst\u00e1v\u00e1 warfarin l\u00e9kem prvn\u00ed volby u mechanick\u00fdch srde\u010dn\u00edch chlopn\u00ed, revmatick\u00e9 mitr\u00e1ln\u00ed sten\u00f3zy, antifosfolipidov\u00e9ho syndromu a vybran\u00fdch vysoce rizikov\u00fdch pacient\u016f, kde jsou d\u016fkazy pro DOAC slab\u00e9.<\/p>\n

Jak warfarin funguje<\/h2>\n

Warfarin inhibuje vitamin K-epoxidredukt\u00e1zu (VKORC1) v hepatocytech, \u010d\u00edm\u017e blokuje recyklaci vitaminu K. To vede k vy\u010derp\u00e1n\u00ed aktivn\u00edch \u03b3-karboxylovan\u00fdch forem faktor\u016f II, VII, IX a X spolu s p\u0159irozen\u00fdmi antikoagulancii proteinem C a S. Antikoagula\u010dn\u00ed \u00fa\u010dinek nastupuje se zpo\u017ed\u011bn\u00edm 3-5 dn\u016f, jeliko\u017e st\u00e1vaj\u00edc\u00ed cirkuluj\u00edc\u00ed faktory jsou katabolizov\u00e1ny \u2014 p\u0159i pot\u0159eb\u011b rychl\u00e9 antikoagulace je nutn\u00e9 p\u0159emos\u0165ov\u00e1n\u00ed parenter\u00e1ln\u00edm heparinem nebo LMWH.<\/p>\n

Schv\u00e1len\u00e9 indikace<\/h2>\n
    \n
  • Mechanick\u00e9 srde\u010dn\u00ed chlopn\u011b<\/strong> \u2014 warfarin je jedin\u00e1 p\u0159ijateln\u00e1 peror\u00e1ln\u00ed mo\u017enost (DOAC jsou kontraindikov\u00e1ny; studie RE-ALIGN)<\/li>\n
  • St\u0159edn\u011b t\u011b\u017ek\u00e1 a\u017e t\u011b\u017ek\u00e1 (revmatick\u00e1) mitr\u00e1ln\u00ed sten\u00f3za<\/strong> \u2014 s fibrilac\u00ed s\u00edn\u00ed nebo bez n\u00ed<\/li>\n
  • Antifosfolipidov\u00fd syndrom (triple-pozitivn\u00ed)<\/strong> \u2014 warfarin s INR 2-3 prok\u00e1zal lep\u0161\u00ed v\u00fdsledky ne\u017e rivaroxaban (TRAPS, 2018)<\/li>\n
  • Fibrilace s\u00edn\u00ed<\/strong> \u2014 pokud jsou DOAC kontraindikov\u00e1ny, nesn\u00e1\u0161enliv\u00e9 nebo finan\u010dn\u011b nedostupn\u00e9; zaveden\u00e1 prevence c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhody<\/li>\n
  • \u017diln\u00ed tromboembolie (DVT a PE)<\/strong> \u2014 l\u00e9\u010dba a prodlou\u017een\u00e1 sekund\u00e1rn\u00ed prevence<\/li>\n
  • Trombus v lev\u00e9 komo\u0159e<\/strong>, postinfarktov\u00fd st\u011bnov\u00fd trombus, dilata\u010dn\u00ed kardiomyopatie s trombem<\/li>\n<\/ul>\n

    D\u00e1vkov\u00e1n\u00ed a c\u00edlov\u00e9 hodnoty INR<\/h2>\n

    D\u00e1vka warfarinu je vysoce individualizovan\u00e1 a titrovan\u00e1 podle mezin\u00e1rodn\u00edho normalizovan\u00e9ho pom\u011bru (INR). Typick\u00e1 udr\u017eovac\u00ed d\u00e1vka je 2\u201310 mg denn\u011b, ale rozsah m\u016f\u017ee b\u00fdt 15 mg.<\/p>\n\n\n\n\n\n\n\n\n\n\n
    Indikace<\/th>\nC\u00edlov\u00e9 INR<\/th>\nPozn\u00e1mky<\/th>\n<\/tr>\n<\/thead>\n
    Fibrilace s\u00edn\u00ed<\/td>\n2,0\u20133,0<\/td>\nC\u00edl 2,5<\/td>\n<\/tr>\n
    \u017diln\u00ed tromboembolie (DVT\/PE)<\/td>\n2,0\u20133,0<\/td>\nC\u00edl 2,5; minim\u00e1ln\u011b 3 m\u011bs\u00edce<\/td>\n<\/tr>\n
    Mechanick\u00e1 aort\u00e1ln\u00ed chlope\u0148 (modern\u00ed dvoulist\u00e1)<\/td>\n2,0\u20133,0<\/td>\nC\u00edl 2,5<\/td>\n<\/tr>\n
    Mechanick\u00e1 mitr\u00e1ln\u00ed nebo star\u0161\u00ed aort\u00e1ln\u00ed chlope\u0148<\/td>\n2,5\u20133,5<\/td>\nC\u00edl 3,0; +kyselina acetylsalicylov\u00e1 p\u0159i velmi vysok\u00e9m riziku<\/td>\n<\/tr>\n
    Antifosfolipidov\u00fd syndrom (triple-pozitivn\u00ed)<\/td>\n2,0\u20133,0<\/td>\n2,5\u20133,5 p\u0159i recidiv\u011b p\u0159i terapeutick\u00e9m INR<\/td>\n<\/tr>\n
    Opakovan\u00e1 VTE p\u0159i terapeutick\u00e9 l\u00e9\u010db\u011b warfarinem<\/td>\n2,5\u20133,5<\/td>\nIndividu\u00e1ln\u00ed posouzen\u00ed specialistou<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    INR se kontroluje denn\u011b p\u0159i zah\u00e1jen\u00ed l\u00e9\u010dby, pot\u00e9 t\u00fddn\u011b do stabilizace a n\u00e1sledn\u011b dlouhodob\u011b ka\u017ed\u00e9 4-12 t\u00fddn\u016f. \u010cas v terapeutick\u00e9m rozmez\u00ed (TTR) nad 65-70 % je kvalitativn\u00edm benchmarkem.<\/p>\n

    Farmakogenomika: VKORC1 a CYP2C9<\/h2>\n

    Pacienti s variantami VKORC1 -1639 G>A (citliv\u00ed) nebo CYP2C9 *2\/*3 (pomal\u00ed metaboliz\u00e1to\u0159i) vy\u017eaduj\u00ed ni\u017e\u0161\u00ed po\u010d\u00e1te\u010dn\u00ed a udr\u017eovac\u00ed d\u00e1vky. Genotypem \u0159\u00edzen\u00e9 d\u00e1vkov\u00e1n\u00ed zkracuje \u010das do stabiln\u00edho INR, ale nen\u00ed rutinn\u011b dostupn\u00e9 ve v\u011bt\u0161in\u011b center.<\/p>\n

    Strava, alkohol a \u017eivotn\u00ed styl<\/h2>\n
    Pravidlo vitaminu K: konzistence, ne vyh\u00fdb\u00e1n\u00ed se.<\/strong> Denn\u011b konzumujte obvykl\u00e9 mno\u017estv\u00ed listov\u00e9 zeleniny (\u0161pen\u00e1t, kapusta, brokolice, r\u016f\u017ei\u010dkov\u00e1 kapusta). N\u00e1hl\u00e9 velk\u00e9 zm\u011bny \u2013 t\u00fddenn\u00ed p\u0159ej\u00edd\u00e1n\u00ed se sal\u00e1tem nebo \u00fapln\u00e9 vynech\u00e1n\u00ed zeleniny \u2013 destabilizuj\u00ed INR. Brusinkov\u00fd d\u017eus, grapefruit a brusinkov\u00e9 tablety mohou zv\u00fd\u0161it INR a m\u011bly by b\u00fdt omezeny. T\u011b\u017ek\u00e1 nebo n\u00e1razov\u00e1 konzumace alkoholu zvy\u0161uje riziko krv\u00e1cen\u00ed a INR; um\u00edrn\u011bn\u00fd pravideln\u00fd p\u0159\u00edjem je p\u0159ijateln\u00fd. Vyhn\u011bte se voln\u011b prodejn\u00fdm bylinn\u00fdm p\u0159\u00edpravk\u016fm (t\u0159ezalka, ginkgo, \u017een\u0161en, \u010desnek, dong quai) bez konzultace s l\u00e9ka\u0159em.<\/div>\n

    Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n