Anticoagulants

Uses: venous thrombosis, pulmonary embolism, AMI

MOA: binds ATIII -> inhibition of coagulation proteases (IXa)

SC (w/ Warfarin) or IV(emergency)

Toxicity: Bleeding, hematuria, thrombocytopenia, osteoporosis

Low molecular weight heparin

MOA: inhibits factor Xa

recombinant of leech saliva protein

Uses: heparin is contraindiacted b/c of induced thrombocytopenia

MOA: inhibits thrombin

Toxicity: bleeding, ab formation

• Used: when need chronic anticoagulation
• MOA: inhibits vit K reductase (in vivo only)

• A/E: protein C inhibition -> skin & tissue necrosis
• fetal toxicity

• Antidote: vit. K
• prothrombin complex
• frozen plasma
• whole blood

• Contra: coagulopathy
• aplastic anemia
• leukemia
• thrombocytopenia
• peptic ulcer

Recombinant protein C

Used: anticoagulation & anti-inflammatory

• MOA: binds Va & VIIIa
• - inc fibrinolysis
• suppress TNF-a, IL6, IL1

Used: stroke prevention in a-fib patient

MOA: competitive inhibitor of thrombin

• AKA reteplase, tenecteplase
• (fibrinolytic)

MOA: = TPA - plasminogen- plasmin- fibrin digestion

• Used: MI (w/in 3 hours)
• pulmonary thromboembolism
• Ischemic stroke (alteplase)

via IV

• A/E: hermorrhage
• systemic lytic state

• Contra: aortic dissection
• w/in 3 months closed head trauma/ ischemic stroke

• Aspirin
• clopidrogel
• abciximab

Antiplatelet

Used: prevent TIA & ischemic stroke

MOA: irreversible block of ADP receptor on platelets -> no fibrinogen -> glycoprotein bond

Antiplatelet (ab)

MOA: Fab binds noncompetitively to glycoprotein IIb/IIIa

• Used:
• coronary stent
• unstable angina

• Vitamin K
• thrombin
• protamine sulphate

Phytonadione

• MOA: counter warfarin toxicity
• hemorrhage in newborn
• hypoprothrombinemia

Clotting drug

from salmon sperm

Used: Heparin counter