Drugs Affecting Coagulation, Bleeding & Thrombosis
1. Platelet inhibitors/ Antiplatelet drugs
- Antiplatelet drugs are drugs which interfere with platelet function and are useful in the prophylaxis of thromboembolic disorders.
E.g.
- Abciximab
- Aspirin
- Cilostazol
- Clopidogrel
- Dipyridamole
- Prasugrel
- Eptifibatide
- Ticagrelor
- Ticlopidine
- Tirofiban
- Glycoprotein (GP) llb / IIIa receptor antagonists
Uses
- Coronary artery disease
- Cerebrovascular disease
- Coronary angioplasty, stents, bypass implants
- Prosthetic heart valves and arteriovenous shunts
- Venous thromboembolism
- Peripheral vascular disease
2. Anticoagulants
- Objective: Prevention of thrombus extension and embolic complications by reducing the rate of fibrin formation.
- They do not dissolve already formed clot, but prevent recurrences.
- Heparin is utilized for rapid and short-lived action, while oral anticoagulants are suitable for maintenance therapy. Generally, the two are started together; heparin is discontinued after 4-7 days when warfarin has taken effect.
E.g.
- Apixaban
- Argatroban
- Bivalirudin
- Dabigatran
- Dalteparin
- Enoxaparin
- Fondaparinux
- Tinzaparin
- Rivaroxaban
- Warfarin
| Used in Vivo | Used in Vitro |
Parenteral
|
|
OralCoumarin derivatives
Indandione derivatives
|
Uses
- Deep vein thrombosis and pulmonary embolism
- Myocardial infarction (MI)
- Unstable angina
- Rheumatic heart disease
- Atrial fibrillation
- Cerebrovascular disease
- Vascular surgery, prosthetic heart valves, retinal vessel thrombosis, extracorporeal circulation, haemodialysis
- Defibrination syndrome (Disseminated intravascular coagulation)
3. Thrombolytic (Fibrinolytic) agents
- Thrombolytics are drugs used to lyse thrombi/clot to recanalize occluded blood vessels (mainly coronary artery).
- They are curative rather than prophylactic; work by activating the natural fibrinolytic system.
- In general, venous thrombi are lysed more easily than arterial, and recent thrombi respond better: little effect on thrombi > 3 days old.
E.g.
- Alteplase (tPA)
- Reteplase
- Streptokinase
- Tenecteplase
- Urokinase
Uses
- Acute myocardial infarction
- Deep vein thrombosis
- Pulmonary embolism
- Peripheral arterial occlusion
- Stroke
4. Anti-thrombolytic (Antifibrinolytic) agents
- Antifibrinolytic agents are drugs which inhibit plasminogen activation and dissolution of clot.
E.g.
- Epsilon aminocaproic acid (EACA)
- Aprotinin
- Tranexamic acid
5. Treatment of Bleeding
E.g.
- Aminocaproic acid
- Protamine sulfate (Heparin antagonist)
- Tranexamic acid
- Vitamin K1 (phytonadione)
