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Anticoagulants

Anticoagulants. Anticoagulants are drugs used to prevent and treat venous thrombosis (DVT) Tow classes: Parenteral & Oral Parenteral anticoagulants: Heparin and enoxaparin MOA: Antithrombin effect thrombin

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Anticoagulants

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  1. Anticoagulants

  2. Anticoagulants are drugs used to prevent and treat venous thrombosis (DVT) Tow classes: Parenteral & Oral Parenteral anticoagulants: Heparin and enoxaparin MOA: Antithrombin effect thrombin Fibrinogen fibrin

  3. Heparin is given I.V; S.C; I.M; I.V infusion; pumps. Heparin is effective in vivo & vitro Heparin major side effects: Bleeding. Management, stop drug and give a specific antidote to heparin protamine sulfate I.V Heparin contraindications: - Any bleeding tendency - Peptic ulcer disease

  4. Low molecular weight heparin Enoxaparin Similar to heparin but more potent Has low M.W Associated with lower incidence of bleeding Its side effects and contraindications are similar to heparin

  5. Oral anticoagulants: Warfarin, phenindione (coumarins) MOA: Have an antivitamin K effect, inhibiting synthesis of vitamin K-dependent clotting factors. Effective only in vivo Given orally Start acting in 2-3 days (have delayed OOA)

  6. Extensively bind plasma proteins (site of drug-drug interactions) Many antibiotics, aspirin…↑ activity of warfarin, barbiturates ↓ its activity Warfarin is usually given with heparin (at the same time) Warfarin side effects: Bleeding, management, stop drug and give its specific antidote, vitamin K I.V

  7. Warfarin contraindications: - Bleeding tendencies - Peptic ulcer disease - During pregnancy Warfarin crosses easily the placenta and could lead to fetal abnormalities Heparin is not contraindicated during pregnancy (doesn’t cross the placenta)

  8. Arterial thrombosis Management: - Eliminate risk factors, ↑ B.P; D.M; smoking; ↑ lipids… - Use of antiplatele drugs, aspirin; clopidogrel; dipyridamole… - Use of fibrinolytic (thrombolytic) drugs

  9. Fibrinolytic (thrombolytic) drugs Drugs that activate plasminogen. Convert plasminogen to plasmin → breaks down fibrin Streptokinase, given in an I.V infusion Alteplase (tissue plasminogen activator-tPA), given in an I.V infusion Anistreplase, given I.V

  10. Clinical uses of fibrinolytic drugs: - Pulmonary embolism - Acute M.I - Central DVT Disadvantages of fibrinolytic drugs: - Expensive - Frequent allergic reactions - Lead to bleeding

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