Accelerate lysis of thrombus in STEMI (patients with UA and NSTEMI do not benefit)
Transform inactive plasminogen to plasmin
When does fibrinolytic therapy need to be administered?
Within 30 minutes of presentation to the hospital
What are some adverse effects of fibrinolytic therapy?
Bleeding Systemic lytic state
In what patients is fibrinolytic therapy contraindicated?
Active peptic ulcers Recent stroke Recent surgery
Interfere with coagulation cascade; goal is to inhibit thrombin activation by Xa, directly inhibit thrombin or decrease functional thrombin production
What is unique about heparin (UFH)?
It can inactivate Xa and inactivate free thrombin
Low MW heparin Enoxaparin Dalteparin Fondaparinux
What is a possible severe side effect of thrombin?
Why would you use LMWH over UFH?
It has a longer 1/2 life and more predictable bioavailability than UFH.
Direct thrombin inhibitor; inhibits independently of antithrombin; acts on circulating and clot-bound thrombin
Irreversibly acetylates COX-1 in platelets; blocks production of thromboxane. Permanent effect.
What patients is aspirin used in?
Patients with UA, acute MI, history of MI; chronic stable angina w/o history of MI; minor stroke; Coronary artery bypass surgery
Inhibit ADP-mediated activation of platelets; ADP activates P2Y1 and P2Y12 -- drugs inhibit P2Y12
Thienopyridines: Clopidigrel, Ticlopidine, Prasugrel, Ticagrelor
Which Thienopyridine is reversible and when is this an advantage?
Ticagrelor -- prevents perioperative bleeding complications w/o a waiting period (lifespan of platelets is 7-10 days)
What are some side effects of Ticagrelor?
Severe neutropenia and thrombotic thrombocytopenic purpura
Used in patients that cannot tolerate aspirin; relatively ineffective; increase platelet cAMP
Reversible inhibit the final common pathway of platelet aggregation -- binding of GPIIa/IIIb to fibrinogen and vWF
Chimeric human mouse antibody; blocks access of fibrinogen and vWF to GPIIa/IIIb receptor; non-competitive; IV
Synthetic peptide; motif that binds GPIIb/IIIa receptors; competitive; IV; renal clearance
New drug, inhibits free and fibrin bound thrombin
New drug, direct Xa inhibitor