Professional Documents
Culture Documents
Blood coagulation
&
Anticoagulants
.
Contents
• Blood coagulation
• Anticoagulants
• Classes of Anticoagulants
• Uses of anticoagulants
• Indirect-acting
• Direct-acting
• Surgery in patients receiving anticoagulant
therapy
• The use of anticoagulants in pregnancy
Blood coagulation
Blood coagulation means the
conversion of fluid blood to a solid
gel or clot. The main event is the
conversion of soluble fibrinogen to
insoluble strands of fibrin by
thrombin ,which is the last step in a
complex enzyme cascade.
Coagulation Cascade
Intrinsic Pathway Extrinsic Pathway
(vessel wall damage) (damaged tissue )
XIIa12
VIIa7
XIa11 tissuethrom
boplastin Heparin / LMWH
IXa9
Xa & V
Thrombin-Fibrin
Clot
Anticoagulants
An anticoagulant is a substance that
prevents coagulation. Anticoagulants
can be used in vivo as a medication
for thrombotic disorders. Some
chemical compounds ( e.g. EDTA )are
used in medical equipment, such as
test tubes, blood transfusion bags,
and renal dialysis equipment.
Classes of Anticoagulants
In active factors 2,7,9,10,& protein c & s. Activated clotting factors
Reduced Vitamin K Oxidized Vitamin K
Warfarin
Onset of action of warfarin
The effect takes several days to
develop because of the time taken
for degradation of preformed
carboxylated clotting factors.
The onset of action thus depends on
the elimination half-lives of the
relevant factors. Factor VII, with a
half-life of 6 hours, is affected first,
then IX, X and II, with half-lives of 24,
40 and 60 hours, respectively
Dose of warfarin
There is much inter-individual variation in
dose
requirements. The usual dose to initiate
therapy is 5-10 mg daily for 2 days, with the
maintenance dose then adjusted according
to
the INR.
• 1. INR 2.0-2.5 Prophylaxis of deep vein
thrombosis
• 2. INR 2.0-3.0 treatment of DVT &
pulmonary embolism.
• 3. INR 3.0-4.5 recurrent DVT &
pulmonary embolism .
MONITORING OF ANTICOAGULANT
THERAPY
MONITORING OF ANTICOAGULANT
THERAPY by INR ( international
normalized ratio ), which is the ratio
of prothrombin time in the patient to
that in a normal (un-anticoagulated)
person.
Adverse effects of warfarin
1. Bleeding (4-8%).