Beruflich Dokumente
Kultur Dokumente
DRUGS USE IN
VENOUS THROMBOEMBOLISM
Dheni Krisnawati
www-admin.med.uiuc.edu/hematology 11
Classification of protein C deficiency :
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Protein C deficiency type I & II
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Treatment of deficiency of
Protein C
Heparin
Warfarin
LMWH
The treatment are generally continued for 3-
6 months
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Deficiency of protein S
Classification Protein S deficiency :
Type I : The function is normal, the amount is
insufficient.
Type II : the amount is normal , unable to
interact with other molecules.
Type III : low amount of protein S, but overall
is normal .
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Deficiency of protein S
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Treatment of deficiency
of Protein S
Heparin or LMWH
Warfarin
The treatment are generally continued for 3-
6 months
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Antithrombin / antithrombin III
deficiency:
Classification of antithrombin deficiency :
Type I : the amount is inadequate, the fuction
is normal.
Type II : the amount is normal, the function is
improper.
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Treatment of antithrombin
deficiency :
Heparin or LMWH
Warfarin
Antithrombin concentrated
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Treatment of antithrombin
deficiency (in pregnancy) :
Heparin or LMWH
Antithrombin concentrated
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ANTIPLATELET AGENT
Aspirin,NSAID:
Inhibit an enzyme COX1 that cause platelet aggregation.
Aspirin is the longest anti platelet action
Dypiridamol:
Mechanism is not clear,use as combine to aspirin,
Side effect:
bleeding,dizziness,hypotension,headache,nausea,flushing,abdo
minal discomfort
Ticlopidine,clopidogrel:
Inhibit ability of ADP to bind to platelet,so inhibit platelet
aggregation. Side effect Clopidogrel :nausea,upset,
stomach,diarrhea,itching,rash,fatique,headache,flu like
symptom,TTP (thrombotic thrombocytopenic purpura).
Ticlopidine side effect like clopidogrel,nephritic
syndrome,hyponatremia,low blood cells
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HEPARIN
A natural subtance in the liver
Mechan. enhance the effect of antithrombin
2 kind:
Unfractionated inhibit FIIa & Xa heparin,IV
Side effect fever, runny nose,itching,irritation in the site of
infusion,,chills,osteoporosis,thrombocytopenia.
Poor absorbed through GIT IV
Monitoring every 6 hours.
LMWH (low molecular weight heparin) inhibit Xa,SC.
Example:enoxaparin,dalteparin,tinzaparin,nadropin,revipari
n,certoparin.
Not require regular monitoring. Antidote protamine sulfate
Pharmacotherapy Handbook,Joseph T Dipiro 24
UF heparin versus LMW Heparin
• Elimination primarily • Elimination mainly
through cellular through a renal
uptake mechanism
• Bioavailability ~ 30% • Bioavailability ~ 90%
• Half-life 1 – 3 hours • Half-life ~ 4 hours
• Accelerates primarily • Accelerates primarily
the inhibition of the inhibition of FXa
thrombin and FXa • Cannot be measured
• Can be measured by by APTT assays
APTT assays
25
Warfarin (coumadin)
Inhibit the effect of vitamin K dependent
clotting factor
(FII/protrombin,FVII,FIX,FX,protein C,protein
S)
Side effect rash,diarrhea, hepatitis,abdominal
pain,nausea, skin necrosis,
Antidote : vitamin K or FFP (fresh frozen
plasma).
Has a long t1/2 & duration of action-drug
accumulation possible and can cause internal
bleeding
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Thrombolitic medication/clot
buster
Break the fibrin clot
3 primary agent :
Streptokinase
Urokinase-type plasminogen activator(UPA)
Tissue-type plasminogen activator(TPA)
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Streptokinase
Large protein that produced from streptococci.
Bind to and activate plasminogen breakdown the
formed fibrin.
Administration : IV
Side effect :
Hemorhage
antigenic anaphylactic reaction.
Hypotension
Resistence to drug.
Tissue plasminogen activator
Developed using recombinant DNA
technology
Used when streptokinase less effective
Prevention DVT
Nonpharmacologic : early ambulation, leg
elevation, exercises, elastic compression, calf
compression,
Low dose unfractionated heparin therapy
www-admin.med.uiuc.edu/hematology
Pharmacotherapy Handbook 2rd.,Joseph
T.Dipiro.,1998
A manual of laboratory and diagnostic test 7th
edition (juli 2003): by France T Fisbach
RN,BSN,MSN
Cherry & Merhats’s complication of pregnancy 5th
edition : by Wayne R Cohen (jan 2000)