anti trom bo tico
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ANTI TROMBANTI TROMBTI COSTI COSANTI COAGULANTES,ANTI COAGULANTES,
ANTI PLAQUETANTI PLAQUET RI OS ERI OS E
FI BRI NOLFI BRI NOLTI COSTI COSProf a. Christianne Brtas Vieira ScaramelloProf a. Christianne Brtas Vieira Scaramello
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ANTI COAGULANTES,ANTI COAGULANTES,
ANTI PLAQUETANTI PLAQUET RI OS & FI BRI NOLRI OS & FI BRI NOLTI COSTI COSFrmacos que impedem a f ormao de
trombos
Anticoagulantes:retardam ou impedem a coagulao
sangunea
Antiplaquetrios:inibem a agregao plaquetria
Fibrinolticos:dissolvem trombos patolgicos e depsitos de
fibrina
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PrevenPreveno da perdao da perdade sanguede sangue
HemostaseHemostase
Leso vascular
Vasoconstrio Agregaoplaquetria
Coagulaosangunea
Tampo hemosttico
TOMBOGNESE HEMOSTASECreate PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
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Coagulao FibrinFibrinliseliseAgregaoplaquetaria
HemorragiaHemorragia
TrombogneseTrombognese
Formao indesejada de um tampo hemosttico
(condio patolgica resultante de hipercoagulao)
TromboseArtria
Necrose I squmia
Tr omboseVeia
Tecidos drenados
Edema e inf lamaoVeia profundaembolia pulmonar
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Coagulao sangunea
Via ExtrVia Extrnsecanseca
Ca++
Trauma tecidualTrauma tecidual
Fator tecidualFator tecidual
XX XaXaVIIVII VIIaVIIa** Ca
++
TrombinaTrombinaCa++
ProtrombinaProtrombina
Fosfolipidos plaquetFosfolipidos plaquetriosrios Ca++VaVa VV
Via IntrVia Intrnsecanseca
FosfolipFosfolipdosdosplaquetplaquetriosrios
Ca++
SuperfSuperfciecieexternaexterna
PrPr--calicrecalicrenana
calicrecalicrenana
XIIXII XIIaXIIa
XIXI XIaXIa
IXIX IXaIXa**
VIVI
IIII
VIIIaVIIIa
XX XaXa
XaXa
Rede de fibrinaRede de fibrina
AtivaAtivaooplaquetplaquetriaria
Tempo de tromboplastinaparcial ativada
Tempo de protrobina
ZI MOGNI OS
Fatores inativos f ormados no f gado.
A TI VA O (I I , VI I , I X , X )
carboxilao do resduo de cidoglutmico
cof ator - vit K reduzida
(restaurada pela vit K redutase)
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2 antiplasmina
(-)
TrombinaTrombinaFibrinognioFibrinognio Monmeros deMonmeros de
fibrinogniofibrinognio
Rede de fibras de fibrinaRede de fibras de fibrina
Fibras de fibrinaFibras de fibrina
TrombinaTrombina
fator estabilizador de fibrina (XIIIa)fator estabilizador de fibrina (XIIIa)
Ca++
PlasminaPlasminognio
(-)
tPA
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Endotlio
Subendotlio
Fator de vonWillebram
Complexo2b 3(antigo GpI I b- I I I a)
f ibrinognio
PlaquetaGpI b
Adeso&
agregao plaquetrias
f ibras de colgeno
TxA2ADP
Plaquetas
vWFvWF: Fator von Willebrand
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Colagno
Adesoplaquetria:Plaquetas unidaspor f ibrinognio
Seqncia decoagulao extrnseca
vWF
Exposio do fatortecidual ligado
membrana
Favorecem a tromboseFavorecem a trombose
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Inativa a trombina, fatores Xa, IXa
Protelise de Va, VIIIa
Ptn C ativa Ptn C
Antitrombina III
trombina PGI2, NO
agregaoplaquetria
Trombomodulina EndotlioMolcula semelhante heparina
I nibem a tromboseI nibem a trombose
(-)
S
+ ativador tecidual de plaminognio (tPA)
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ANT I COAGULANT ES
?ao dos fatores de coagulao
HeparinaHeparinas de baixo peso
molecular
Enoxaparina
DalteparinaCertoparina
Antagonistas da trombina
Hirudina Hirulog Lepirudina
Anticoagulantes orais
VarfarinaDicumarol
Femprocumom
Classif icaClassif icao dos Antitrombo dos Antitrombticosticos
ANTI PLAQUETRI OS
Inibio da formao de TXA2
Inibidor COX
Aspirina
Inibidor TXA2 sintase
Dazoxiben
RidogrelAntagonista TXA2
Ridogrel
GR32191
Inibidores dos receptores
2b 3 (GpIIb / IIIa)Abciximab
Tirofiban
FI BRI NOL TI COS
Catalisam converso de
plasminognio em plasminaEstreptoquinase
Uroquinase
Inibidor de PDE
DipiridamolAntagonista do
receptor para ADP
Ticlopidina
Clopidogrel
Anlogos PGI2Epoprostenol
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ANT I COAGULANT ES PARENTERAI SANT I COAGULANT ES PARENTERAI S
HEPARI NASHEPARI NAS
(McLean, 1916)
Fontes: mucosa intestinal suna, pulmo bovino
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MECANI SMO DE AO
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Usos clnicos Ef eitos indesejados
Profilaxia e tratamentodo tromboembolismo
venoso
Angina instvel (+ AAS)Infarto agudo do
miocrdio
Hemodilise
Hemorragia
Trombocitopenia
Leses cutneas
Osteoporose
Hipoaldosteronismo
Hipercalemia
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Farmacocintica
2 4 6 8 10 h
Administrao subcutnea
t1/2
= 40 90 min
35000 UI / 8 12 h
[H]
5000 UI
1200 - 1600 UI
Infuso contnua
Janela teraputica: 0,3 0,7 U / mL
[H]
Superdosagem:sulfato de protamina 1 %
No atravessa a placenta
Monitorizao laboratorial
TTPa = Tempo de Tromboplastina parcial ativada
Avaliao da via intrnseca
Sangue calcificado + fosfolipdeos
Coagulao
Normal 26 33 segundos
heparina 1,5 a 2,5 x maior
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LMWH:LMWH: Biodisponibilidade SC; efeito previsvel; auto-administrao; baixo
ndice de trombocitopenia; risco de sangramento e osteopenia
DANAPARDANAPARIDEIDE (Orgaran)::contra fator Xa, s/ antdoto, monitorar c/ anti-Xa
84% heparan
12% dermatan
4% condroitina sulfato
LEPIRUDINALEPIRUDINA (Refludan): fator IIa- s/antdoto, ac anti-hirudina, cuidado c/
insuficincia renal
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ANTI COAGULANTESANTI COAGULANTES
ORAI SORAI S
EUA, 1920
Derivados de 4-OH
cumarinas: Varfarin (Marevan)
Dicumarol
Derivados de indan-1,3-
diona:
Anisindiona
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MECANI SMO DE AO
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t1/2de protenas dependentes de vitamina K:
Protena Tempo (h)
Fatores de coagulao
Fator VII 6
Fator IX 24
Fator X 36
Protrombina 50
Protenas anticoagulantes
Protena C 8
Protena S 30
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Usos clnicos Ef eitos indesejados
Profilaxia e tratamento do
tromboembolismo venoso
Valvopatias e prteses
valvares
Infarto agudo do
miocrdio Fibrilao atrial
no valvar
Hemorragia
Distrbios GI
Necrose cutnea (ptn C)
Prpura
Dermatite urticariforme
Alopecia
TeratogenicidadeCreate PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
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Farmacocintica
Biodisponibilidade VO 80 100 % (ou IV)
99 % ligao a albumina plasmtica (interao AAS)
Metabolismo heptico
Fase I CYP2C9
variantes allicos 10 a 20 % caucasianos menor dose
Interaes: ? [varfarina] - Cimetidina, cloranfenicol
?J[varfarina] - Barbitricos, carbamazepina
Fase II - glicuronidao
Excreo renal (t1/2= 25 60 h)Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
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Superdosagem:administrao de vitamina K, plasma fresco
Monitorizao laboratorial
TP = Tempo de Protrombina
Avaliao da via extrnseca
Sangue calcificado + tromboplastina
coagulao
Normal 12 14 segundos
Varfarin ndice normalizado Internacional (INR)
INR = TP paciente
TP controle = 2 a 4
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ANTI PLAQUETANTI PLAQUET RI OSRI OS
AAS(160 320 mg / dia VO)Indicaes: Acidente vascular cerebral
Aps cirurgia de derivao coronarianaNova estenose aps angioplastia ou trombliseInfarto do miocrdioCrise isqumica transitria
t1/2= 2 3 h; ligao a protenas plasmticas = 50 70 %
TI ENOPI RI DI NASTiclopidina (Ticlid)dose de ataque 500 mg; dose usual 250 mg / 2x dia; t
1/2= 30 h
Clopidrogrel (Plavix)dose de ataque 300 mg; dose usual 75 mg / diaProvavelmente pr-frmacosIndicaes: Acidente vascular cerebral; Angioplastia (+ AAS)Efeitos indesejados: Neutropenia reversvel, trombocitopenia, nuseas, vmitos, diarria,rashes cutneos
I nibidores do receptor I I b/ I I I aTirofibam (Aggrastat) t1/2= 30 min - Abciximab (Reopro) - Eptifibatide (Integrelin)
Indicaes: Angioplastia, anginaPreveno de restenoseInfarto do miocrdio (+AAS e heparina)
Efeitos indesejados: Hemorragia, trombocitopenia
Efeitos indesejados:Irritao GI dose-dependenteHipersensibilidade
Sindrome de Reye em crianas
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AAS
AAS +clopidogrel
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FI BRI NOLFI BRI NOLTI COSTI COS
Usos clnicos: IAM, trombose
venosa profunda, embolia
pulmonar (IV)
t1/ 2
0 10 20 90
AnistreplaseAnistreplase
EstreptoquinaseEstreptoquinase
UroquinaseUroquinase
tt--PAPA
Ativao doplasminognioAnistreplaseAnistreplase
Estreptoquinase (Strptase)Estreptoquinase (Strptase)
Uroquinase (Abbokinase)Uroquinase (Abbokinase)
tt--PA (Alteplase)PA (Alteplase)
Antigenicidade
AnistreplaseAnistreplase
EstreptoquinaseEstreptoquinase
UroquinaseUroquinase
tt--PAPA
Efeitos indesejados:Hemorragia, reaes de hipersensibilidadeSuperdosagem:cido aminocaprico e cido tranexmico
Contra-indicaes:Cirurgia (< 10 dias), trauma, ressucitao cardiopulmonar,sangramento GI (< 3 meses), hipertenso, sangramento / hemorragia, AVC prvio,
disseco artica, pericardite aguda
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