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Thrombosis prevention of venous thrombosis and

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Unformatted text preview: X, Blocks and prothrombin and 18 Warfarin, an Oral Anticoagulant Warfarin, Therapeutic uses Therapeutic – Not useful in emergencies – Long-term prophylaxis of thrombosis Prevention of venous thrombosis and associated Prevention pulmonary embolism pulmonary Prevention of thromboembolism (in patients with Prevention prosthetic heart valves) prosthetic Prevention of thrombosis during atrial fibrillation 19 Warfarin, an Oral Anticoagulant Warfarin, Monitoring treatment – Prothrombin time (PT) time in which Prothrombin something clots: if too long, someone is at risk for bleeding – INR Adverse effects – Hemorrhage (vitamin K for toxicity) – Fetal hemorrhage and teratogenesis from use Fetal during pregnancy during – Use during lactation – Black stools 20 Warfarin, an Oral Anticoagulant Warfarin, Drug interactions – Drugs that increase anticoagulant effects – Drugs that promote bleeding – Drugs that decrease anticoagulant effects – Heparin- IV – Aspirin- thrombolytic effects Aspirin– Acetaminophen 21 Warfarin, an Oral Anticoagulant Warfarin, Warfarin overdose – Vitamin K Dietary vitamin K- if you eat things high in Dietary vitamin K it will reduce warfarin effect (restrict bananas, green-leafy vegetables) (restrict Contrasts between warfarin and heparin 22 Diagnostic Tests to Monitor Anticoagulants Anticoagulants • Heparin Activated partial thromboplastin time---normal Activated 20-30 seconds---1.5—2.5 times the control in seconds seconds • Warfarin (Coumadin) Prothrombin time---normal 12—15 seconds--therapeutic anticoagulation 1.5 to 2x the pt. therapeutic baseline baseline International Normalized Ratio (INR)—2.5 International considered therapeutic in most situations. considered 23 Antiplatelet Drugs Antiplatelet Aspirin (ASA) – Inhibition of cyclooxygenase – Adverse effect Increases risk for GI bleeding Ticlopidine (Ticlid) – Inhibits ADP-mediated aggregation – Adverse effects Hematologic effects Clopidogrel (Plavix) – ADP receptor antagonist 24 Aspirin (ASA) Aspirin Therapeutic uses – Ischemic stroke – TIA – Chronic stable angina – Unstable angina – Coronary stenting – Acute MI – Previous MI – Primary prevention of MI 25 Aspirin (ASA) Aspirin Adverse effects – Bleeding – GI bleeding and hemorrhagic stroke – Enteric-coated tablets may not reduce the risk Enteric-coated for GI bleeding for 26 Clopidogrel (Plavix) Clopidogrel Therapeutic uses – Prevents blockage of coronary artery stents – Reduces thrombotic events in patients with Reduces acute coronary syndromes acute MI, ischemic stroke, and vascular death Similar adverse effects to those of aspirin Use with caution in combination with other Use drugs that promote bleeding drugs 27 Antiplatelet Drugs Antiplatelet Glycoprotein (GP) IIb/IIIa receptor Glycoprotein antagonists antagonists – Most effective antiplatelet drugs – “Super aspirins” – Reversible blockade of platelet GP IIb/IIIa Reversible receptors receptors 28 Thrombolytic Drugs Thrombolytic Streptokinase (Streptase); Alteplase (tPa) Major adverse effect – bleeding (minor Major oozing to life-threatening amount) oozing – Likely sites of bleeding Recent wounds, needle puncture sites, invasive Recent procedure sites procedure Anticoagulants increase the risk for Anticoagulants hemorrhage hemorrhage Blood replacement may need to be Blood considered considered 29 30 30 Embolism Embolism 31 32 32 Streptokinase (Streptase) Streptokinase Binds to pl...
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