1. Anticoagulants

2. Tow classes: Parenteral & Oral Parenteral anticoagulants:
Anticoagulants are drugs used to prevent and treat venous thrombosis (DVT)
Tow classes: Parenteral & Oral
Parenteral anticoagulants:
Heparin and enoxaparin
MOA: Antithrombin effect
thrombin
Fibrinogen fibrin

3. Heparin is given I. V; S. C; I. M; I. V infusion; pumps
Heparin is given I.V; S.C; I.M; I.V infusion; pumps. Heparin is effective in vivo & vitro
Heparin major side effects:
Bleeding. Management, stop drug and give a specific antidote to heparin protamine sulfate I.V
Heparin contraindications:
- Any bleeding tendency
- Peptic ulcer disease

4. Low molecular weight heparin
Enoxaparin
Similar to heparin but more potent
Has low M.W
Associated with lower incidence of bleeding
Its side effects and contraindications are similar to heparin

5. Oral anticoagulants:
Warfarin, phenindione (coumarins)
MOA:
Have an antivitamin K effect, inhibiting synthesis of vitamin K-dependent clotting factors. Effective only in vivo
Given orally
Start acting in 2-3 days (have delayed OOA)

6. Extensively bind plasma proteins (site of drug-drug interactions)
Many antibiotics, aspirin…↑ activity of warfarin, barbiturates ↓ its activity
Warfarin is usually given with heparin (at the same time)
Warfarin side effects:
Bleeding, management, stop drug and give its specific antidote, vitamin K I.V

7. Warfarin contraindications:
- Bleeding tendencies
- Peptic ulcer disease
- During pregnancy
Warfarin crosses easily the placenta and could lead to fetal abnormalities
Heparin is not contraindicated during pregnancy (doesn’t cross the placenta)

8. Arterial thrombosis
Management:
- Eliminate risk factors, ↑ B.P; D.M; smoking; ↑ lipids…
- Use of antiplatele drugs, aspirin; clopidogrel; dipyridamole…
- Use of fibrinolytic (thrombolytic) drugs

9. Fibrinolytic (thrombolytic) drugs
Drugs that activate plasminogen. Convert plasminogen to plasmin → breaks down fibrin
Streptokinase, given in an I.V infusion
Alteplase (tissue plasminogen activator-tPA), given in an I.V infusion
Anistreplase, given I.V

10. Clinical uses of fibrinolytic drugs:
- Pulmonary embolism
- Acute M.I
- Central DVT
Disadvantages of fibrinolytic drugs:
- Expensive
- Frequent allergic reactions
- Lead to bleeding