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11 Cards in this Set
- Front
- Back
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APTT/PTT |
Activated Partial Thromboplastin Time (APTT) = Intrinsic pathway, heparin
Prothrombin Time (PTT) = Extrinsic pathway, warfarin |
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Coagulation/Fibrinolysis Pathway |
-여러 가지 coagulation factor 가 서로를 activation 시킨다. Factor10 이 활성화되고 Ca 도 관여한다. Factor 2 (prothrombin)가 activation 되면 이게 fibrinogen 을 잘라서 fibrin을 만든다. 이게 intrinsic pathway. -(tissue injury 에 의해) Factor 7 이 activation 되면 factor 10을 활성화 시키는데 이게 ext pathway 이다.
-응고되는 걸 녹이는 기전도 존재한다. Fibrin을 녹이는 게 plasmin 이다. Plasminogen 에서 잘려야 활성화 된다. 여기게 관여하는 게 tPA 이고 endo 에서 나와서 혈관벽에 응고가 되는 것을 막는다. -Anticoagulant target 은 common path 를 target 으로 하면 가장 효과적이다. Ca 을 막거나 factor 10, thrombin 등을 막을 수 있다. |
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Anticoagulant Drugs |
Activated clotting factors = Heparin Clotting factors = Warfarin Thrombin = Hirudun, lepirudin, bivalirudin
Bleeding tendency 있는 경우 사용 x. 아스피린 복용할 때 사용 x. |
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Thrombin Inhibitor = Heparin |
종류: extracted heparin, Low MW heparins, synthetic heparin derivatives (fondaparinux, idraparinux) 부작용: HIT (heparin-induced thrombocytopenia)
작용기전: Antithrombin의 결합력을 증가시킨다. 효과: aPTT 증가, PT 그대로. |
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Advantages of LMWH over H |
a. More predicable and reproducible pharmacokinetic profile (no need to monitor) b. Longer plasma half-life : 4~6 h vs. 0.5~1 h c. Lower incidence of thrombocytopenia and thrombosis : less interaction with platelet factor 4 : fewer heparin-dependent IgG generation |
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Clinical Uses of Heparin |
Clinical Use: IV infusion or SC injection. initial management before oral anticoagulant Tx.
Side Effect: -Rebound thrombosis -Liver toxicity -Osteoporosis -Low aldosterone, high K+ |
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Heparin-induced bleeding 막는 법 = Protamine 사용 |
Protamine Toxicity
-protamine: + charged, heparin 억제 -Bleeding tendency by interacting with platelet and fibrinogen
-Anaphylactic response occur in diabetic patients who have been presensitized by protamine Zn insulin
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Direct thrombin inhibitors =Hirudin, Lepirudin, Bivalirudin |
-오래 사용하면 Ab가 형성될 수 있다. -Bivalirudin: synthetic thrombin binding peptides, less immunogenic. |
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Coumarin Anticoagulants |
-Coumarin, Warfarin
Clinical Use: p/o, thromboemblism, arterial occlusion.
Side effects: bleeding. 시금치 등으로 예방 가능. + Drug interaction (enhancement || inhibition) |
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Thrombolytic Agents |
a. Streptokinase: binds/induces conformational change of plasminogen to be activated. b. Tissue plasminogen activator: a proteolytic enz from vascular endothelial cells, useful for treating coronary thrombosis. c. Urokinase |
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Antiplatelet Agents |
a. Aspirin: inhibits ADP release, prostaglandin/thromboxane A2 synthesis in platelet b. Ticlopidine, clopidogrel: Bind and inhibit P2Y12 receptor on platelet surface, thereby inhibiting platelet aggregation. 참고로 clopidogrel은 prodrug. c. Glycoptn IIb/IIIa inhibitors: -Abciximab, Eptifibatide, Tiorofiban -A platelet surface integrin (Gp Iib/IIIa) is a receptor for fibrinogen and final common pathway for platelet aggregation
-Administered parenterally |
