heparin Resistance

heparin Resistance - Journal Session Dr Wan Zaidah Abdullah...

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Journal Session Dr Wan Zaidah Abdullah
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Agenda Heparin resistance BJA, 2002 vol 88, no 4, 467-469 J A M Anderson and E L Saenko
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Overview Heparin was discovered in 1916 Most widely used anticoagulant but not all its actions are fully understood Eg: pain relief in i.v administration for the treatment of DVT, how HIT developed and what is the relevance of the occurrence of heparin resistance
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Indications Prevention of VTE Treatment of VTE Acute coronary syndrome Surgery: cardiac bypass
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Introduction Heparin is a negatively charged sulphated glycosaminoglycan composed of alternating uronic and glucoronic acid residues Commercially prepared are isolated fr porcine int mucosa or bovine lungs. There are heterogenous mixtures of polysacharide chains ranging in molecular weight from 3000 to 30,000. Mode of action:
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MOA 1 1. Antithrombin dependent -Activate AT Hep-AT complex inactivate thrombin, fXa and other coagulation factors The combination of disaccharide units makes- up pentasacharide sequence containing high affinity binding site for AT. This sequence occurs in only about 1/3 rd of heparin chains and is randomly distributed
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MOA 2 2. AT independent Direct Inhibition of the intrinsic tenase complex ( PL complex of FVIIIa, FIXa which generates Fxa) * In plasma milieu, AT-dependent effect predominates In vivo, variation in response to a fixed dose of heparin occurs bet individuals Pharmacokinetics limitation of heparin caused by the binding of hep to plasma proteins Heparin resistance state
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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heparin Resistance - Journal Session Dr Wan Zaidah Abdullah...

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