DRUGS AFFECTING COAGULATION,

BLEEDING AND THROMBOSIS

There are two natural mechanisms involved in various sophisticated process
that occurs between damaged wall of blood vessel , coagulation factors and
platelets, they are hemostasis and blood coagulation. The mechanism through
which the blood clot is forming are proteolytic reactions ( hydrolysis of protein
bonds).
Two major systems that are involved in the process of blood clotting are:

Intrinsic system:In this system Hageman Extrinsic system:This system gets

factor gets activated ,factors for this system
are found in plasma and this pathway gets
activated when there is a endothelial damage
in the blood vessel this process is slow,
hence for the activation of Factor X it takes
few minutes.
activated when there is a tissue
damage.This pathway requires
tissue thromboplastin (tissue
factor).In this system it only
takes few seconds for the
activation of factor X.

Following circumstances are common to both systems which results in

conversion of fibrinogen to fibrin strands and occlusion of blood cells in those
strands forms blood clot.
These are several laboratory parameters used for evaluating intrinsic and
extrinsinc system they are
 Prothrombim time (PT)
 Activated partial thromboplastin time (aPTT)
In general the clotting factors that are found in plasma present as inactive form.
Almost all clotting factors are proteins they undergo partial proteolysis and gets
converted into active form and they in turn activate next factor. Eg thrombin
which activates many intrinsic factors especially V, XI and VIII, it also
activates platelets.
Alternatively, there are several factors that affects coagulation process which
degrades the blood clot, they are protein C, protein S, antithrombin ,
antithromboplastin, and fibrinolysin system. Hence the balance of these two
systems helps to retain the fluid nature of the blood and also produce hemostasis
in response to an injury or trauma.

COAGULANTS
Coagulants are substances that helps to enhance coagulation that is very useful
in bleeding conditions. Clotting factors that are involved in blood coagulation
are naturally found in Fresh whole blood or Fresh frozen plasma , however
these clotting factors acts immediately in response to haemorrhage. Drugs that
causes blood coagulation are :

VITAMIN K
k1: Phytonadione
(Phylloquinone)
k2 : Menadione
Acetamenaphthone
Menadione sodium

bisulfite

COAGULANTS

MISCELLANEOUS
Fibrinogen (human)
Antihaemophilic factor
Desmopressin
Adrenochrome mono
-semicarbazone
Ethamsylate
Rutin
 INTRINSIC PATHWAY EXTRINSIC PATHWAY

XII – inactive serine protease Tissue injury

XIIa – active serine protease VIIa VII

(endothelial damage) XIIa

SLOW TFIII XIa FAS
XI XIa Kallikrein
Ca++ Ca++
IX IXa
VIIIa Ca++
X Xa X
va Ca++
Prothrombin thrombin

FIBRINOGEN FIBRIN (soluble)

XIIIa THROMBIN

FIBRIN (insoluble)

[TF III – Tissue factor, Ca++ ions are responsible for the activation of several
coagulation factors ]