Pharm Block 2 (Antithrombotic drugs)

• 1. Anti-Coagulants-- Venous Side
• 2. Fibrinolytic-- Destoying Clots (MI)
• 3. Anti-Platlet-- Arterial Side

-These are more for Prevention of Clots in the Venous thromboemboli, prevention of strokes in patients with AFib, and the prevention and treatment of acute coronary syndrome (ACS)


- This is used for disolution of pre-existing clots and play an important role in acute treatment of thrombosis.

• - Heparins
• - Vitamin K antagonists
• - Direct thrombin inhibitors

Heparin= Unfractionated Heparin. Meaning that it has its long polysaccharide tail AND its specific Pentasaccharide sequence that is responsible for its activity.

LMWH= Low molecular weight heparin meaning that it only has the short Pentasaccharide portion. Still has the same effect as Heparin, but is Specific for Factor X.

It Enhances the activity of Endogenous Anticoagulant Antithrombin III by increasesing its affinity for Thrombin

• Antithrombin II also inhibits factors X,IX and XI
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• LMWL does the same thing but is Specific for Factor X

• -It is Highly ionized so it is not available orally, only via IV. Since it is Ionized it cannot cross the Placenta membrane and thus is a good treatment it Pregnent women.
• - It is dose dependent (Zero order), thus half life is dependent on dose.

It can cause Thrombocytopenia and some bleeding

• - it is selective for factor X
• - better bioavailability (80%)
• -longer acting
• - no lab monitoring required
• -LOW RISK for thrombocytopenia
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• Enoxaparin
• Dalteparin
• Tinzaoarin

Protamine Sulfate

• -Strongly basic
• - Less effective against LMWH

It is a Direct factor X inhibitor ( a Synthetic form of LMWH)

-Has very very low rist for Thrombocytopenia

-They are drugs that directly inhibit throbin with out involving Anti-thrombin drugs or vitamin K

- us it in patients with heparin induced thrombocytopenia (thus cannot used heparin to prevent clotting).

• Hirudin
• Argatroban
• Lepirudin

-It is a heparinoid consisting of heparin sulfate, dermatan sulfate and chondroitin sulfate

-has greater anti-factor X activity then LMWH

- used it in patients with heparin induced thrombocytopenia