Drugs

Drugs Affecting Coagulation, Bleeding & Thrombosis

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

  • Heparin
  • LMW Heparin (Enoxaparin, Reviparin, Nadroparin, Dalteparin, Pamparin, Ardeparin, Fondaparinux)
  • Heparinoids (Heparan sulfate, Danaparoid, Lepirudin, Ancrod)
  • Heparin
  • Calcium complexing agents (Sodium citrate, Sodium oxalate)
OralCoumarin derivatives

  • Bishydroxycoumarin (Dicumarol)
  • Warfarin sodium
  • Acenocoumarol (Nicoumalone )
  • Ethylbiscoumacetate

Indandione derivatives

  • Phenindione

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)
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