Antithrombotics Flashcards
Name antiplatelet drugs
NSAIDS (aspirin), platelet GPIIB/IIIA receptor blockers (Abciximab, eptifibatide, Tirofiban), ADP receptor blockers (ticlopidine, clopidogrel), Phosphodiesterase inhibitor (dipyridamole)
Clinical uses of aspirin
- Prophylactic treatment of transient cerebral ischemia 2. to reduce the incidence of recurrent myocardial infarction 3. To decrease mortality in postmyocardial infarction patients.
Side effects of aspirin
Bleeding (PGI2) Gastric upset and ulcers (PGE2) *gastrointestinal bleeding
Clinical use of GPIIB blocker
Prevent restenosis after coronary angioplasty and are used in acute coronary syndromes
Name the anticoagulants
Heparin derivatives, coumarin derivatives (warfarin), lepirudin and hirudin, antithrombin III
Clinical use of heparin and warfarin
1.Treatment of deep-vein thrombosis, pulmonary embolism, and acute myocardial infarction.
- Can be used in combination with thrombolytics for revascularization and in combination with GP IIb/IIIa inhibitors during angioplasty and placement of coronary stents.
- Can be used when an anticoagulant must be used in pregnancy (e.g., treatment of venous thromboembolism [VTE]), but not warfarin
How to give heparin
IV or subcutaneously but not IM cuz it leads to haematomas
Side effect of heparin
Haemorrhage: stop heparin therapy + protamine sulfate (cationic peptide) Thrombocytopenia
Adverse effects of warfarin
- bleeding
- warfarin should never be administered during pregnancy.-Warfarin crosses the placenta readily and can cause a hemorrhagic disorder in the fetus. Fetal proteins with gamma-carboxyglutamate residues found in bone and blood may be affected by warfarin; so growth of fetus affected.
Name thrombolytic agents
Tissue plasminogen activator (alteplase), urokinase, streptokinase, anistreplase
Clinical uses of thrombolytic agents
- Emergency treatment of coronary artery thrombosis. 2. Peripheral arterial thrombosis and emboli 3. Ischaemic stroke (< 4.5 hr window)
Side effects of thrombolytic agents
Bleeding, no use in pregnancy or healing wounds
Heparin vs LMWH
Low molecular weight heparins (LMWHs) have better bioavailability and longer half-life compared to regular (unfractionated) heparin, but it does not increase action of AT III on thrombin since it is necessary for heparin to bind to both AT III and thrombin.
