Anticoagulant

From Wikipedia, the free encyclopedia

Jump to:navigation, search An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some chemical compounds are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis equipment.

Contents

1 As medications o 1.1 Coumarins !itamin " antagonists# 1.1.1 Adverse effects 1.1.$ Available agents o 1.$ %eparin and derivative substances 1.$.1 &o' molecular 'eight heparin 1.$.$ Synthetic pentasaccharide inhibitors of factor (a 1.$.) *a+or pharmaceutical %eparin recall due to contamination o 1.) ,irect thrombin inhibitors o 1.- .ther types of anticoagulants $ /eneral indications ) Anticoagulants outside the body - See also 0 1eferences

[edit] As medications
Anticoagulants reduce blood clotting. 2his prevents deep vein thrombosis, pulmonary embolism, myocardial infarction and stro3e.

[edit] Coumarins (Vitamin K antagonists)

4urther information: !itamin " antagonist 2hese oral anticoagulants are a class of pharmaceuticals that antagoni5e the effects of vitamin ". 67amples include 'arfarin. 8t ta3es at least -9 to :$ hours for the anticoagulant effect to develop. ;here an immediate effect is required, heparin must be given concomitantly. 2hese anticoagulants are used to treat patients 'ith deep<vein thrombosis ,!2#, pulmonary embolism =6#, atrial fibrillation A4#, and mechanical prosthetic heart valves.

[edit] Ad erse effects =atients aged 9> years or more may be especially susceptible to bleeding complications 'ith a rate of 1) bleeds per 1>> person<years.?1@ 2hese oral anticoagulants are used 'idely as poisons for mammalian pests, especially rodents. 4or details, see rodenticide and 'arfarin.# ,epletion of vitamin " by coumarine therapy increases ris3 of arterial calcification and heart valve calcification, especially if too much vitamin , is present.?$@ [edit] A aila!le agents

;arfarin Coumadin# This is the main agent used in the U.S. and UK?)@ Acenocoumarol and phenprocoumon This is used more commonly outside the U.S. and the UK Arodifacoum Rat poison, not used medically =henindione

[edit] "eparin and deri ati e su!stances

%eparin is a biological substance, usually made from pig intestines. 8t 'or3s by activating antithrombin 888, 'hich bloc3s thrombin from clotting blood. %eparin can be used in vivo by in+ection#, and also in vitro to prevent blood or plasma clotting in or on medical devices. !acutainer brand test tubes containing heparin are usually colored green. [edit] #o$ molecular $eight heparin &o' molecular 'eight heparin is a more highly processed product that is useful as it does not require monitoring of the A=22 coagulation parameter it has more predictable plasma levels# and has fe'er side effects. [edit] %ynthetic pentasaccharide inhi!itors of factor &a

4ondaparinu7 is a synthetic sugar composed of the five sugars pentasaccharide# in heparin that bind to antithrombin. 8t is a smaller molecule than lo' molecular 'eight heparin. 8draparinu7

[edit] 'a(or pharmaceutical "eparin recall due to contamination 8n *arch $>>9 ma+or recalls of %eparin 'ere announced by pharmaceuticals due to a suspected and un3no'n contamination of the ra' %eparin stoc3 imported from China ?-@ ?0@ . 2he contaminant 'as later found to be a non<naturally occurring compound called oversulfated chondroitin sulfate ?B@. 2he C.S. 4ood and ,rug Administration 'as quoted

as stating that at least 1D deaths 'ere believed lin3ed to a ra' %eparin ingredient imported from the =eopleEs 1epublic of China, and that they had also received :90 reports of serious in+uries associated 'ith the drugFs use. According to the Ge' Hor3 2imes: E=roblems 'ith heparin reported to the agency include difficulty breathing, nausea, vomiting, e7cessive s'eating and rapidly falling blood pressure that in some cases led to life<threatening shoc3E.

[edit] )irect throm!in inhi!itors

*ain article: direct thrombin inhibitor Another type of anticoagulant is the direct thrombin inhibitor.?:@ Current members of this class include argatroban, lepirudin, bivalirudin, and dabigatran. An oral direct thrombin inhibitor, 7imelagatran 67anta# 'as denied approval by the 4ood and ,rug Administration 4,A# in September $>>- ?1@ and 'as pulled from the mar3et entirely in 4ebruary $>>B after reports of severe liver damage and heart attac3s. ?$@

[edit] *ther types of anticoagulants

*any other anticoagulants e7ist, for use 1esearch I ,evelopment, and more or less uses as drug candidates or diagnostics

+atro,o!in, a to7in from a sna3e venom that clots platelet<rich plasma 'ithout affecting platelets functions lyses fibrinogen#.

[edit] -eneral indications

2herapeutic uses of Anticoagulants include:

Atrial fibrillation, =ulmonary embolism =6#, ,eep vein thrombosis ,!2#, or !enous 2hromboembolism !26#, %eart failure, Stro3e, *yocardial infarction, /enetic or acquired hypercoagulability

[edit] Anticoagulants outside the !ody

&aboratory instruments, test tubes, blood transfusion bags, and medical and surgical equipment 'ill get clogged up and become nonoperational if blood is allo'ed to clot. Chemicals can be added to stop blood clotting. Apart from heparin, most of these chemicals 'or3 by binding calcium ions, preventing the coagulation proteins from using them.

6,2A is denoted by mauve or purple caps on !acutainer brand test tubes. 2his chemical strongly and irreversibly binds calcium. 8t is in a po'dered form. Citrate is usually in blue !acutainer tube. 8t is in liquid form in the tube and is used for coagulation tests, as 'ell as in blood transfusion bags. 8t gets rid of the

calcium, but not as strongly as 6,2A. Correct proportion of this anticoagulant to blood is crucial because of the dilution. 8t can be in the form of sodium citrate?disambiguation needed@ or AC,. .7alate has a mechanism similar to that of citrate. 8t is the anticoagulant used in fluoride grey top# tubes.

For the meaning of more colors, see Vacutainer#including coagulants.

[edit] %ee also

Anticoagulation in pregnancy Agro*edic < *edicinal &eeches,*alaysia &eeches %irudinaria *anillensis# Staying Active and %ealthy 'ith Alood 2hinners ,!, by the Agency for %ealthcare 1esearch and Juality