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Dr. Anusha Vohra

Objective Objective At the end students should be able to : -�Classify fibrinolytics and antifibrinolytics. �Describe their mechanism of action, uses and adverse

effect.�Enumerate their contraindications.

FIBRINOLYTICS: therapeutic ??

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??????� What is the mechanism??� On which thrombi they work better and why???�Streptokinase, Urokinase�Alteplase, reteplase, tenecteplase

USESUSES1. Acute MI within 12hrs of onset2. Deep vein thrombosis3. Pulmonary embolism4. Peripheral artery thromboembolism5. For unclotting of catheters and shunts6. Acute thrombotic stroke within 3 hrs

????� What is the role of aspirin and heparin after

thrombolytic therapy??� Facilated PCI???

Complication

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Contraindications to thrombolytic therapy1. H/o Intracranial haemorrhage2. H/o Ischaemic stroke in past 3 months3. H/o Head injury in past 3 months4. Intracranial tumour/vascular abnormality/aneurysms5. Active bleeding/bleeding disorders6. Peptic ulcer, esophageal varices7. Any wound or recent fracture or tooth extraction8. H/o major surgery within 3 weeks9. Uncontrolled hypertension9. Uncontrolled hypertension10. Pregnancy

ANTIFIBRINOLYTIC DRUGS??� USES: to control/prevent excessive bleeding due to: -1. Fibrinolytic drugs.2. Cardio-pulmonary bypass surgery.3. Tonsillectomy, prostatic surgery, tooth extraction in

haemophiliacs.4. Menorrhagia, especially due to IUCD.5. Recurrent epistaxis, hyphema due to ocular trauma,

peptic ulcer.peptic ulcer.

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Adverse effectAdverse effect� Thromboembolicevents� EACA: rapid IV-hypotension, bradycardia,

arrhythmias

Antiplatelet agents� Decreases platelet aggregation and inhibits thrombus

formation. � Useful in prophylaxis of thromboembolic disorders

Pathophysiology of Thrombus formation

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Antiplatelet Drugs1. TXA2 synthesis inhibitor: Aspirin2. Phosphodiesterase 3 inhibitor: Dipyridamole3. P2Y12 (ADP) Receptor Blockers : Ticlopidine,

Clopidogrel, Prasugrel4. GPIIb/IIIa Antagonists: Abciximab, Eptifibatide

Tirofiban

Mechanism of Action

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?????IMPORTANT POINTS?????IMPORTANT POINTS� Aspirin: antiplatelet dose -70-150mg/day?? � Why low dose??? Not other NSAIDs??� Prolongation of bleeding time lasts for 5 -7days.??� If Ibuprofen is taken within 2hrs prior to aspirin??� Dipyridamole potentiates PGI2 action. Role??� Pateints with unstable angina should not use dipyridamole????use:

stroke (TIA)prevention with aspirin, PHV with warfarin � Ticlopidine, clopidogrel, prasugrel, ticagrelor and cangrelor??� Ticlopidine: severe hamatologicreactions� Clopidogrel and poor metabolizers/ omeprazole???� DAPT??-(Clopidogrel with aspirin etc)� Ticagrelor effectiveness decrease when used with aspirin doses above

100mg.

????� GPIIb/IIIa receptor inhibitors???� Abiciximab, Eptifibatide, Tirofiban� Caution with abiciximab??� CILOSTAZOL: intermittent claudication�Contraindication: heart failure � Antiplatelet agents more effective in arterial

thrombosis??

USES: prophylactic treatment1. Coronary artery disease2. Acute coronary syndromes (ACSs)3. Cerebrovascular disease4. Prosthetic heart valves and arteriovenous shunts5. Venous thromboembolism6. Peripheral vascular disease

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TOXICITY????

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summarisesummarise

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