Anti-Coagulants Flashcards
Factors that predispose to thrombosis:?
1) Atheromatous plug rupture;
2) Altered blood flow- Blood stasis (atrial fibrillation and long flights);
3) abnormal coagulability
(Pregnancy, oral contraceptives and thrombophilia);
4) Thrombi can break away forming an embolus. It can interrupt blood flow causing ischemia or infarction
Drugs used in the tx of Venous Thrombi?
Anticoagulants
Drugs used in the Tx of Arterial thrombi?
Antiplatelets
Anticoagulant Drugs
1) Heparins (LMWH,HMWH) - 1st line
2) Hirudins (direct thombin inhibitors) - 2nd line
3) Novel oarl Anticoagulants (NOAC) -
direct thrombin inhibitros and Selective Xa inhibitors
4) Vitamine K Antagonists
Clinical uses of Heparin (HMWH/LMWH)
1st line
- DVT
- PE
- MI
* safe in pregnancy
* LMWH are prefered over HMWH
LMWH examples
* Low molecular weight heparin (LMWH)
enoxaparin,
dalteparin,
fondaparinux
- parin
Contraindications of LMWH
1) renal failure (As they are eliminated by renal excretion)
2) ATIII deficiency (rare) –> can cause Thrombophilia
Heparin inhibits thrombin (IIa) and factor Xa activation. How?
Actiavtion of ATIII (Anti-thrombin III), thus ATIII conformation changes and increases its affinity for serine proteases–> inhibits Thrombin (IIa) and factor Xa.
What is the pathogenesis of Heparin-induced Thrombocytopneia (HIT)
IgG Abs form a complex w/ Heparin bound to platelet factor IV –> platelet activation -> thrombosis –> ↓↓ Platelets
- LMWH are less likely to cause HIT than HMWH
MoA of LMWH
LMWH increases the action of ATIII on Xa only –> it cannot increase the action on ATIII on thrombin and it cannot bind both simultaneouslY
**Act mainly on factor Xa ONLY**
what is used to reverse Heparin AE?
Protamine sulfate
AE of Heparin
1) Haemorrage (bleeding)
2) Heparin -induced Thrombocytopenia (HIT) - caused mainly by Unfractioned Heparins (HMWH)
3) Osteoperosis
4) Drug-Drug rxn- hypersensitivity
5) Hyperaldosteronism (w/ Hyperkalaemia) - Uncommon but monitore K+ levels if tx is to be continued for > 7days
Administration of HMWH
IV- they cannot be absorbed from the gut
Monitoring method for HMWH (Unfractioned Heparin)
Activated Partial Thromboplastin Time (aPTT)
- The dose must be adjusted to reach a value within a target range (eg 1.5-2.5 times control)
Monitoring method for LMWH
anti-Factor Xa assays
NOTE:
Monitoring not required routinely,eliminated
mainly by renal excretion
Direct thrombin inhibitors Examples
Hirudins
Lepidurin,
Bivalirudin,
Argatroban(IV)
LAB
MoA Bivalirudin, Argatroban, Dabigatran?
Direct thrombin inhibitors (Factor IIa)