The Clot Cascade

Question 1

Plasmin

Answer 1

Clot busting endogenous protease
Cleaves arg-Lys bonds
Degrades factor 1, 2, 5, 7

Question 2

Anistreplase

Answer 2

Clot busting
Plasminogen + anisoylated streptokinase combined
Slow acting, prolonged

Question 3

Alteplase

Answer 3

Clot busting
Single chain recombinant human tissue plasminogen activator
Selective for plasminogen bound to fibrin

Question 4

Aspirin in combination with ______

Answer 4

Clopidogrel —-] ADP binding on platelets —] aggregation
Clot busting
Aspirin —-] thromboxane —-] aggregation

Question 5

Eptifibatide

Answer 5

Clot busting

Peptide inhibitor of glycoprotein IIa which promotes platelet aggregation

Question 6

Tirofiban

Answer 6

Clot busting
Non peptide Glycoprotein IIa inhibitor
Prevents fibrin mediated platelet aggregation
Preventative

Question 7

Heparin

Answer 7

Endogenous clot buster
Produced by bø and mast cells
Binds and activates enzyme antithrombin III
ATIII —] thrombin, 5
Used in DVT, thromboemboli in cats and prophylactically (surgery)
IV administration

Question 8

Warfarin

Answer 8

Orally acting clot buster
Inhibits vitamin K epoxide reductase
-----] factor 2, 7, 9, 10
Food interactions makes it unsuitable for long term doses
Rodent resistance

Question 9

Dabigatran

Answer 9

Clot busting
Thrombin inhibitor
Prophylactic, atrial fibrillation, stroke

Question 10

Rivaroxaban

Answer 10

Clot buster (new)
Factor 10 inhibitor

Question 11

Aminocaproic acid

Answer 11

Clot forming
Used in excessive bleeding due to OD on clot busters
Competitively inhibits plasminogen activation

Question 12

Tranexamic acid

Answer 12

Clot forming
Used in excessive bleeding due to OD on clot busters
Competitively inhibits plasminogen activation

Question 13

Streptokinase

Answer 13

Clot busting

Binds and activates plasminogen activating enzyme