Thrombosis Flashcards
Unfractionated Heparin
Class: Indirect thrombin inhibitors
Mechanism: Bind antithrombin, potentiating formation of antithrombin-coagulation factor complex (Xa, IIa)
Therapeutics: Prevention and treatment of venous thromboembolism
Side Effects: HIT, osteoporosis (long-term)
Low Molecular Weight
Name: Indirect thrombin inhibitors
Mechanism: LMWH that inhibits thrombin less effectively than Xa
Therapeutics: Prevent thrombosis and embolism from clots
Fondaparinux
Class: Indirect thrombin inhibitors
Mechanism: Synthetic polysaccharide that binds active site of antithrombin; inhibits Xa
Therapeutics: Given for HIT patients
Side Effects:
Warfarin (Coumadin)
Class: Vitamin K antagonist
Mechanism: Blocks vitamin K-dependent gamma-carboxylation of factors II, VII, IX, X, Protein C and S (does not affect already synthesized factors)
Therapeutics: Long-term anticoagulation
Side Effects: Thrombosis (Protein C depression)
Dabigatran
Class: Direct thrombin inhibitor
Mechanism: Inactivate fibrinogen-bound AND unbound thrombin; competitive (reversible)
Side Effects: No antidote, mortality with hemorrhages
Rivaroxaban (Xarelto)
Class: Direct Xa inhibitor
Mechanism: Reversible bind active site of Xa
Apixaban (Eliquis)
Class: Direct Xa inhibitor
Mechanism: Reversible bind active site of Xa
Streptokinase (Streptase)
Class: Fibrinolytic
Mechanism: Lyse already formed clots by activating circulating plasminogen (not clot specific)
Therapeutics: Acute MI, acute stroke, central DVT, multiple PE
Urokinase (Kinlytic)
Class: Fibrinolytic
Mechanism: Lyse already formed clots by activating circulating plasminogen
Therapeutics: Acute MI, acute stroke, central DVT, multiple PE
Reteplase (Retavase)
Class: Fibrinolytic
Mechanism: Lyse already formed clots; more clot specific, less systemic activation
Therapeutics: Acute MI, acute stroke, central DVT, multiple PE
Tenecteplase (TNKase)
Class: Fibrinolytic
Mechanism: Lyse already formed clots; more clot specific, less systemic activation
Therapeutics: Acute MI, acute stroke, central DVT, multiple PE
Aspirin
Class: Antiplatelet
Mechanism: Irreversibly inhibits platelets, preventing thromboxane A2 formation
Therapeutics: Often as “baby aspirin” to prevent and treat MI and stroke
Dipyridamole (Persantine)
Class: Antiplatelet
Mechanism: PDE inhibitor –> increase in platelet cAMP
Therapeutics: Weak antiplatelet effect
Clopidogrel (Plavix)
Class: Antiplatelet
Mechanism: Inhibits platelet ADP receptors
Side Effects: TTP (rare)
Abciximab (Reopro)
Class: Antiplatelet
Mechanism: Monoclonal antibody against GP IIb/IIIa
Side Effects: May elicit immune response
