Anticoagulant Drugs
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- Опубликовано: 29 сен 2024
- CORRECTION - Spoken mistake in the first minute of the video -- The oldest drug on this video is heparin, NOT Warfarin.
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ADDITIONAL TAGS
Anticoagulant Drugs
Commonly used blood thinners for treating venous thromboses
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Warfarin
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Inhibits Vitamin K regeneration
Therefore, inhibits Vit K-dependant factors
Coag factors II, VII, IX, and X and protein C and S
Warfarin
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Vitamin K
Vit K epoxide reductase
Vitamin K epoxide
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Warfarin
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Inhibits Vitamin K regeneration
Therefore, inhibits Vit K-dependant factors
Coag factors II, VII, IX, and X and protein C and S
Requires bridging with use
Warfarin blocks II, VII, IX, X, C, and S
C, a coagulation cascade inhibitor, runs out first
So if used alone, Warfarin has a COAGULATIVE effect at first
Use with other coagulant for first five days
Otherwise, skin necrosis
Can be taken orally, effects require a few days
NOT compatible with pregnancy
Heparin
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Very negatively charged carbohydrate
Polysaccharide with sulfate groups
Binds to antithrombin
Inhibits thrombin (IIa) and coag factor Xa
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Heparin
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Very negatively charged carbohydrate
Polysaccharide with sulfate groups
Binds to antithrombin
Inhibits thrombin (IIa) and coag factor Xa
Heparin must be 5 sugars long to bind AT and 18 sugars to inhibit thrombin in the heparin-AT complex
Heparin monitored with Anti-Xa levels
Coag factor Xa activity measured based on decrease in rate of: X → Xa
Antidote is positively-charged protamine sulfate
Administered subcutaneously, incurs effects immediately
Enoxaparin (Low Molecular Weight Heparin)
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Polymers approximately one third the size of big Heparin
Cannot complex with antithrombin to inhibit thrombin
Enoxaparin is not the required 18 sugars long
Affects coag factor Xa, as measured with Anti-Xa test
Improved effects against VTE associated with cancer
Fondaparinux (“tiny Heparin†)
Pentasaccharide portion of heparin binds to antithrombin
Cannot complex with antithrombin to inhibit thrombin
Affects coag factor Xa, as measured with Anti-Xa test
Synthetically made, unlike others that are animal extracts
Does not induce HIT, unlike the others
New Oral Anticoagulants
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
NOACs cause fewer intracranial bleeds
NOT used in patients with mechanical heart valves
Rivaroxaban and Apixaban
Inhibit factor Xa
Metabolized in the liver
Dabigatran
Direct thrombin inhibitor
Cleared through kidneys
Argatroban
Warfarin
Heparin
Enoxaparin
(LMWH)
Fondaparinux
(tiny Heparin)
NOACs
Argatroban
Direct thrombin inhibitor
No need for antithrombin
Therefore it inhibits all three coagulation tests
TT, PT, and PTT
Used in cases of HIT
Metabolized in the liver
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you're wrong. Enoxaparin does bind to antithrombin, and inhibits factor Xa and IIa, however it has much greater anti-factor Xa activity than IIa activity.
thanks for sharing. corrections: your warfarin slide incorrectly circles fibrinogen and not prothrombin. also at 6:25, it says heparin is subcutaneous- that should be SC or IV.
pro trick : watch series on flixzone. I've been using it for watching lots of of movies recently.
@Emmitt Keaton Yup, I've been watching on Flixzone} for years myself :)
i don't get why warfarin requires bridging with another coagulant , shouldn't be an ANTI-coagulant ? since we dont want excessive coagulation to begin with ! and i thought heparin binds to antithrombin no matter how long the polysccharide heparin chain is , it just doesn't form a hug with the thrombin when it's less than 18 sugar long
+Anfal Ziar
You're right on both points -- sorry about the mistakes, and I'll have it fixed in the video (as annotations) soon. Thanks for pointing that out!
Warfarin is bridged with a shorter-acting ANTIcoagulent:
"Bridging anticoagulation refers to giving a short-acting blood thinner, usually low-molecular-weight heparin..., when warfarin is interrupted and its anticoagulant effect is outside a therapeutic range."
circ.ahajournals.org/content/125/12/e496.full
Heparin binding to AT:
"Molecules of heparin with fewer than 18 saccharides lack the chain length to bridge between thrombin and AT and therefore are unable to inhibit thrombin."
atvb.ahajournals.org/content/21/7/1094.full
other than this the video's been very instructive thanks
+Anfal Ziar
Warfarin is initially pro-coagulant because it depletes Protein C first, which is its self an anti-coagulant. After a few days Warfarin will start to work fully and act as an anti-coagulant. These first few days need to be bridged with another drug like Clexane in order to 'bridge' this period.
it also takes time to inhibit the formation of new coagulation factors when stopping the formation of potassium , the few coagulation factors in the blood before the administration are always effective nd so the anticoagulation isn't obsereved untill 4 to 5 days after the administration when the coagulation factors in the blood have ran out
A couple incorrect statements were mentioned.
Factor II was not circled, but Factor I was circled when mentioning procoagulant factors affected by Vitamin K epoxide reductase.
UFH can be used IV in addition to SQ.
Infact, iv is the conventional method.
And anticoagulants don’t treat VT they prevent them
on point!
LMWH does bind ATIII which then complexes with Xa.
heparin is also used in IV drip. mostly correct but very generic info
3:00 wouldn´t it be "another anticoagulant"? not "another coagulant"... , thanks.
Please let me know: does the blood clot injections hurt? I'm 75 kg pregnant at 9 months, this Friday I have cesarean still I get these injections? Thank u indeed!
yes they hurt! I've been injecting lovenox since Feb twice a day..I ice before n after but it still hurts n I get huge hematomas n bruises
oh my god ,, i am in love with you MFer
you damn good.
f the university
over all top class....thanks doc...
On one slide you say fonda can be used with HIT and on the next you say it can't
How does Jane Fonda factor into this? :)
Yea he said it doesn’t induce HIT and then says it’s does when he was talking about Argatroban...
thanks