Coagulation Flashcards
Treatment of thromboembolism:
1.) Anticoagulant- Parenteral
2.) Anticoagulant- Oral
3.) Anti-platelets
4.) Thrombolytics (name 3 drugs)
Name drugs in each class and what we need to know them
Oh no you’re bleeding! Who’s more at risk?
Name some anti-fibrinolytic or hemostatic drugs
Higher risk for elderly women/ pt w renal failure - heparin bleed
Aminocaproic Acid
Tranexamic Acid (TXA)
Vitamin K, Plasma fractions
(Factor replenishers)
Plasminogen to Plasmin Pathway
Rivaroxaban
Factor 10 inhibitor
Anti-coagulant- clot prevention for DVT
Apixaban
Factor 10 Inhibitor
Anti-coagulant- clot prevention for DVT
Warfarin :)
Direct thrombin Inhibitor, target thrombin and DVT
Blocks vitamin K reductase and blocks carboxylation of glutamate residues. Reduce factor
OD/Bleed? Vitamin K, Replenish factors 2, 7, 9, 10, FFP
TOXIC:
-Birth defects, hemorrhagic disorder in fetus, cutaneous necrosis
Indirect Thrombin Inhibitors
What do they target, MOA?
Drugs?
-Unfractionated Heparin (^risk HITT)
-LMW Heparin
Dalteparin (Fragmin)
LMW Heparin (Target venous thrombus)
More specific for factor 10
Indirect Thrombin Inhibitor
Enoxaparin (Lovenox)
LMW Heparin (Target venous thrombus)
More specific for factor 10
Indirect Thrombin Inhibitor
Tinzaparin (Innohep)
LMW Heparin (Target venous thrombus)
More specific for factor 10
Indirect Thrombin Inhibitor
Fondaparinux (Arixtra)
Heparin
But not selective for Factor 10, no antibody response
What do these check for? Normal values?
INR
PT
aPTT
INR: Time it takes to clot compared to control (Warfarin goal 2-3, normal 0.8-1.2)
PT: Time to clot. (checking extrinsic pathway so factor 7,10, thrombin)
aPTT: activated partial thromboplastin time (checking intrinsic pathway)
Protamine Sulfate
Reversal for heparin
Argatroban
(Not on study guide)
Direct Thrombin Inhibitor
*Active thrombin Site
Melagatran
Direct Thrombin Inhibitor
*Active thrombin Site
Dabigatran (Pradaxa)
Direct Thrombin Inhibitor
*Active thrombin Site
Hirudin (Lepriudin)**
Direct Thrombin Inhibitor
*Bind to both active & substrate recognition sites of thrombin
Bivalirudin (Angiomax)
(not on study guide)
Direct Thrombin Inhibitor
*Bind to both active & substrate recognition sites of thrombin
Streptokinase
Fibrinolytic (Clot bustahhh)
-Catalyze formation of plasmin
-Synthesized by streptococci
t-PA (Altepase)
Fibrinolytic (Clot bustahh)
-**Preferentially activates plasminogen that is BOUND to fibrin/ confined fibrinolysis of formed thrombus
-NOT systemic activation
Urokinase
Fibrinolytic, clot bustah, (# TEAM BLEED)
-Catalyze formation of plasmin
-Synthesized by kidney
-Lyses thrombus from within
Clopidogrel*
Adverse effects?
Anti-platelet/ “Plavic”
-Irreversibly inhibits adenosine diphosphate receptor on platelet
Adverse:
N/D/ dyspepsia (indigestion)
Hemorrhage, leukopenia
Ticlopidine (Ticlid)*
Adverse Effects??
Anti-platelet/
-Irreversibly inhibits adenosine diphosphate receptor on platelet
Adverse:
N/D/ dyspepsia (indigestion)
Hemorrhage, leukopenia
Abciximab
*Monoclonal Antibody
Anti-Platelet
GPII A Receptor Blocker
GPII B Receptor Blocker
Dipyridamole (Persantine)
Anti-platelet
*Inhibits cGMP phosphodiesterase activtiy
*Inhibits adenosine reuptake
Abciximab
*Monoclonal Antibody
Anti-Platelet
GPII A Receptor Blocker
GPII B Receptor Blocker
Aspirin
Anti-platelet
*Prevents arterial thrombus
*Decrease platelet aggregation
Heparin Induced Thrombocytopenia (HIT)
Heparin induced thrombocytopenia
Body -> antibodies to heparin and platelet
only happens to some patients but ^ risk with unfractionated
What do Protease Inhibitors do?
Prevent clot from forming
Disseminated Coagulation (DIC)
MOA? Causes/ Treatments?
**Overstimulation of blood clotting mechanism Use up all of your clotting factors = clots and spontaneous bleeding :(
Aminocaproic Acid
*Anti-Fibrinolytic Inihibitor (#team clot)
Competitively inhibits plasminogen activation
Tranexamic Acid (TXA)
*Anti-Fibrinolytic Inihibitor (#team clot)
DVT
Causes? White vs Red thrombus
DVT: Endothelial injury, stasis, hyper coagulability
Red thrombus: Low pressure vein/ PE
White thrombus: High pressure artery/downstream ischemia
Process of thrombogenesis
Platelet phases?
Roles of the various mediators:
(PGI2, collagen vWF, ADP, TXA2, 5-HT)
Injury -> serotonin-> vasoconstriction
Injury -> collagen/vWF-> cascade
Platelet phases:
1.) Adhesion
2.) Aggregation
3.) Secretion of pro-coag proteins
4.) Cross-link of adjacent plt
- Draw the coagulation cascade including the intrinsic, extrinsic, and common pathways.
Damage to endothelium -> Collagen/vWF/elastin (intrinsic)
Damage to tissue -> Tissue factor (Extrinsic)
Desmopressin Acetate**
Increases Factor 8 activity
**TEAM CLOT!
Coagulation Modifier Drugs. What do they each do?
1.) Anti-coagulant
2.) Anti-platelet drugs
3.) Thrombolytic Drugs
4.) Hemostatic/ Antif-ibrinolytics
Anti-thrombin
A Protease inhibitor
-Rapidly inactivates the coagulation proteins
A Protease inhibitor
-Rapidly inactivates the coagulation proteins
Thrombotic Thrombocytopenic Purpupura (TTP)**
-ADAMST13: gene provides instructions for making an enzyme that is involved in regulating blood clotting
-Disorder that causes Microvascular clots to form in small blood vessels throughout body
-FFP
Warfarin Pharmacokinetics
% Oral availability?
Half life?
Time of Delay?
100% Oral Bio
36 hours half life (LONG)
8-12 hours delay of action– can give hep
Vitamin K
“Koagulation Vitamin”
Works on what factors?
Factor 7, 9, 10
Prothrombin
Discovered in Denmark, necessary for efficient blood coagulation
When would you give plasma fractions?
Hemophilia (disorder where body cant clot properly)
AT III Deficiency
any deficiencies in plasma coagulation factors
