fibrinolitiktrombolitik, antikoagulan dan antiplatelet
TRANSCRIPT
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Endang Sulistyowati N, M.Sc., Apt
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HemostasisThe process that leads to the stopping of bleeding
Trombosis pembentukan trombus di vaskuler, jika mengalir bersama aliran darah disebut embolus
Hemostasis involves :PlateletsCoagulation/Clotting cascade (include fibrin)Blood vessels (endothelium)Inhibitory/control mechanism
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When the endothelium is damaged vasoconstriction and underlying collagen is exposed to circulating platelets.
Platelet membran bind directly to collagen-specific Glycoprotein Ia/IIa and Ib surface receptors and strengthened by von Willebrand factor (vWF) which is bundled in subendothelium.
Three main process of platelets are : adhesion (1 – 3 seconds after injury)activation (platelets release ADP and TXA2 more platelets stimulation and produce new fibrins) aggregation (3 – 7 minutes)
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Consist of : the tissue factor pathway (the extrinsic pathway) and the contact/surface activation/ amplification pathway (the intrinsic pathway)
Extrinsic pathway is the initiation of blood coagulation
It was previously thought that coagulation cascade consisted of two pathways of equal importance joined to a common pathway (Fibrin produced)
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Protein C is a major physiological anticoagulant
Antithrombin is a serine protease inhibitor (serpin)
Tissue factor pathway inhibitor (TFPI)
Plasminogen plasmin (catalyzed by tissue plasminogen activator/ t-PA) which is synthesized and secreted by endothelium
Prostacyclin (PGI2) activates adenylyl cyclase which synthesizes cAMP that inhibits platelet activation
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a. Parenteral Unfractionated heparin (UFH) LMWH (enoxaparin, nadroparin) Fondaparinux
b. Oral Warfarin, rifaroxaban, dabigatran
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Extracted from porcine intestinal mucosa or bovine lung
LMWH lower risk for bleeding and heparin induced trombositopenia, doesn’t cause thrombin inhibition
Administer : SubcutaneousContinuous intravenous infusion
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Novel oral factor Xa and direct thrombin (IIa) inhibitors and their respective targets in the coagulation cascade
Cabral, K. P. & Ansell, J. (2012) Oral direct factor Xa inhibitors for stroke prevention inatrial fibrillation
Nat. Rev. Cardiol. doi:10.1038/nrcardio.2012.19
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Pharmacokinetic and pharmacodynamic characteristics of oral factor Xa inhibitors
Cabral, K. P. & Ansell, J. (2012) Oral direct factor Xa inhibitors for stroke prevention inatrial fibrillation
Nat. Rev. Cardiol. doi:10.1038/nrcardio.2012.19
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Aspirin Inhibit production of Thromboxan A2
Dose : 50 – 320 mg/day Dipiridamol
Increasing cAMP vasodilator Ticlopidin
Inhibition of ADP-activated platelet P2Y1 receptor Dose : 250 mg twice daily
ClopidogrelDose : 75 mg/day, Less leucopenia n trombositopenia
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Streptokinase produced by Streptococcus β-hemoliticus
t-PA (tissue plasminogen activator)AlteplaseReteplase
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Acute Myocardial Infarction
During CABG, PCI, stent placement
Stroke ischemia
Venous Thromboembolism (VT)
Pulmonary Embolism
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Clotting time, Drugs Interaction Antikoagulan heparin aPTT 26 – 33 detik (variatif)
(+kaolin) activated Partial Tromboplastin Time
PTT 12 – 14 detik (+tromboplastin) Prothrombin time
Antikoagulan oral INR (International Normalized Ratio)
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Bleeding assest underlying cause Lab : Prolonged PTT/aPTTOthers .. Red/Dark urine or stools, Gums bleed
Antidot tranexamat acid, protamin sulfat
Trombositopenia diganti dgn Bivalirudin
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