Drugs Affecting Coagulation: Anti Platelets, Anti Coagulants, Thrombolytics

drugs affecting coagulation
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Here you can find videos related to drugs affecting coagulation, including anti-coagulants, anti-platelets and thrombolytics…

Cardiovascular pharmacology deals with the study of the effects of drugs upon the heart or circulatory system. Cardiovascular medicines help to prevent and treat cardiovascular disease, slow the progression of it as well as treat its symptoms whilst providing a better quality of life and increasing life expectancy.

Types of Cardiovascular Drugs include:

  • Anti-Hypertensive Drugs
  • Anti-Angina Drugs
  • Anti-Arrhythmic Drugs
  • Anti-Coagulants
  • Anti-Hyperlipidaemic Drugs

Below you can find a collection of videos that can help provide a more visual approach to cardiovascular pharmacology, specifically on the Anti-Platelet drugs, Anti-Coagulant Drugs and Thrombolytic Drugs.

Drugs affecting coagulation include:

Anti Platelet Drugs – alter formation of platelet plug

Aspirin:

  • Effect lasts for up to 10 days, which is approximately the platelets lifespan.
  • INDICATED FOR: transient ischaemic attack, prevention of ischaemic stroke and MI, acute MI, Angina (chronic stable and unstable).
  • ADVERSE EFFECTS: GI bleeding, haemorrhagic stroke.
  • DOSE: 75mg-150mg daily.
  • MAJOR DRAWBACKS: allergic reactions, lack of effectiveness as an anti-thrombotic drug, lack of response in some patients, irreversible platelet inhibition.

Clopidogrel:

  • INDICATIONS: prevents blocakage of coronary artery stents, reduces thrombotic events in patients with acute coronary syndrome, prevents stenosis of coronary stents.
  • ADVERSE EFFECTS: easy bruising, dyspepsia, increased risk of bleeding.
  • MAJOR DRAWBACKS: increased risk of bleeding (attention when used in combination to other drugs that promote bleeding), limited bioavailability, must be broken down to be activated, patients respond differently to it due to metabolic differences.

Abciximab / Eptifibatide (Glycoprotein IIb/IIIa receptor antagonists):

  • Most effective anti platelet drugs which can be reversed.
  • INDICATIONS: acute coronary syndrome, percutaneous coronary interventions.
  • ADVERSE EFFECTS: bleeding.

Anti Coagulant Drugs – interfere in the clotting cascade and thrombin formation

Warfarin & Coumarins – Vitamin K Antagonists (reduce blood clotting by reducing Vitamin K).

Warfarin:

  • Stops coagulation by decreasing the production of 4 clotting factors that are dependent on Vitamin K.
  • Administered orally at the same time each day with or without food.
  • Initial onset 6-12 hours, with the peak effect developing after several days.
  • Effect persists for 2-5 days after discontinuation.
  • INDICATION: long term prophylaxis of thrombosis, prevention of thromboembolism and venous thrombosis, prevention of thrombosis in atrial fibrillation, reduction of recurrent ischaemic attacks and MI.
  • CONTRAINDICATED: in pregnant and lactating women as it passes through the placenta and breast milk.
  • ADVERSE EFFECTS: bleeding signs & symptoms, haemorrhage.
  • DOSE: 2-5mg depending on INR results.
  • PATIENT EDUCATION: will need ongoing monitoring through INR testing (International Normalised Ratio). Normal INR is usually less or equal to 1, but for patients on Warfarin, INR should range between 2-3, and rechecked every 4 weeks after stabilisation. Should be stopped 5 days before elective surgery. Check for food interactions. Must inform all healthcare providers of Warfarin use. Wear medication bracelet at all times.

Dabigatran, Rivaroxaban, Apixaban: NOAC (Novel Oral Anticoagulants)

Dabigatran:

  • Directly inhibits thrombin production which then prevents formation of fibrin and clots.
  • DOSE: 150BD orally every 12hrs at the same time each day.
  • INDICATION: atrial fibrillation, hip replacement, knee replacement.
  • ADVERSE EFFECTS: bleeding which could be fatal, GI disturbance, dyspepsia.
  • ANTIDOTE: Idarucizumab countaracts bleeding caused by Dabigatran.
  • CONTRAINDICATION: not to be used in patients being administered medications with increased bleeding risk.
  • PATIENT EDUCATION: should not be discontinued prematurely as it causes increased risk of thrombolitic events; must be stopped 2-5 days before elective surgery.

Rivarobaxan and Apixaban:

  • Reduce thrombin production by inhibiting selectively factor Xa and prothrombinase activity.
  • Does not require ongoing lab testing.
  • INDICATION: prevention of DVT and PE after hip and knee surgery, treatment of DVT and PE unrelated to surgery, prevention of stroke in patients with atrial fibrillation.
  • DOSE: same time each day once or twice daily.
  • ADVERSE EFFECTS: dyspepsia, increase risk of bleeding which could be fatal.
  • CONTRAINDICATION: not to be used in patients being administered medications with increased bleeding risk.
  • PATIENT EDUCATION: should not be discontinued prematurely as it causes increased risk of thrombolitic events; must be stopped 2-5 days before elective surgery.

Heparin:

  • Used when rapid anticoagulation is required or quick reversal due to its rapid onset.
  • May be used in pregnant or lactating women.
  • DOSE: in units, administered IV or SC, with preferred administration site being the abdominal area 2″ away from the umbilical cord, thighs or buttocks. Rotate injection site to avoid skin damage. Stop 6-12 hours prior to elective surgery.
  • INDICATIONS: DVT (deep vein thrombosis), Pulmonary Embolism, Arterial Thromboembolism, MI, unstable Angina.
  • ADVERSE EFFECTS: haemorrhage, heparin-induced thrombocytopenia, hypersensitivity reactions.
  • CONTRAINDICATIONS: Thrombocytopenia (low platelet level), uncontrollable bleeding. DO NOT ADMINISTER during or immediately after eye, brain or spinal cord surgery.
  • UNFRACTIONED HEPARIN: APTT monitoring essential, higher risk, antidote Protamine Sulphate used to reverse effects.
  • LOW MOLECULAR WEIGHT HEPARIN: no APTT monitoring needed, lowers risk of bleeding, osteoporosis and Heparin-induced Thrombocytopenia, no antidote.

Thrombolytic Drugs – stimulate the plasmin system to break down the formed clot

Streptokinase, Anistreplase and Urokinase (Non-Fibrin Specific)

Alteplase, Reteplase and Tenecteplase (Fibrin Specific Tissue Plasminogen)

CONTRAINDICATIONS OF THROMBOLYTICS: active internal bleeding, intracranial trauma, cerebral haemorrhagic stroke, cerebrovascular disease, major surgery in the past 2 weeks, active peptic ulcer, diabetic retinopathy, pregnancy.

Drugs Affecting Coagulation: Blood Thinners

Heparin

Warfarin

PT/INR vs aPTT

Thrombolytics

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Simple Nursing and Registered Nurse RN

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Claire
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Author: Claire

Claire Galea is a mum of three currently in her final year following a Degree in Nursing at the Faculty of Health Sciences, University of Malta, as a mature student. Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing. Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.