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An Jie
Chapter 29 Agents affecting blood and hematopoietic organ
Thrombosis – the formation of reaction happens in normal physiological state, but it’s very slow and weak.
In the presence of heparin (which acts as an catalyst), it will be accelerated by more than 1,000 times
Characteristics of anticoagulative effect
effective both in vivo and in vitro
quick onset and potent effects
efficacy positively relative to mocular weight
Pharmacological effects
effects
adjusting blood lipid
anti-inflammatory effect
anti-proliferative effect on vascular
smooth muscle cell
inhibiting pletelet aggregation
…….
Clinical uses
1) thromboembolic disease:
deep venous thrombosis(DVT),
pulmonary embolism, unstable angina,
acute myocardial infarction, cerebral infarction
DIC (Disseminated intravascular coagulation): early stage
extracorporal circulation
(eg. dialysis machine)
Adverse reactions
Spontaneous hemorrhage :
monitoring of aPTT
antagonist: protamine sulfate(1mg:100u)
Heparin-induced thrombocytopenia:
(a decrease in circulating platelets)
2～10 days of therapy, 3% ,
Others : allergic reaction
osteoporosis(骨质疏松)
Contraindications:
1. Bleeding tendency:
Severe hypertension
Ulcer
surgery of the brain ,eye, spinal cord
2. pregnancy
3. Renal and hepatic dysfunctions
LMWHS (low molecular weight heparins)
Weaker effect than heparin
Low incidence of hemorrage
Long-lasting effect
Small individual deviation
No need to monitor generally
Coumarin derivatives ---Oral anticoagulants
These agents are often referred to as oral anticoagulants because they are administered orally, which exists as the main difference from heparin.
Warfarin(华法林),
Dicoumarin(双香豆素)
Acenocoumarin (醋硝香豆素)
pharmacokinetics
Absorption: rapid and complete (warfarin)
Dist