ANTIPLATELETS,

ANTICOAGULANTM AND
THROMBOLYTIC DRUGS

Hina Karim

NES Instructor

Coagulation Physiology

GLOSSARY

Antithrombin III A protein found in our bloodstream

that controls our clotting mechanism and prevents
excessive clotting. It functions as a naturally occurring
mild blood thinner.
Blood Clot Blood that has been converted from a
liquid to a solid state. Also called a thrombus.
Coagulation complex process by which clots form in
the blood.

Fibrin is a solid substance (formed from

fibrinogen) that makes a clot harder to break up.
It forms the mesh or net that holds platelets in
place.
Fibrinogen A specialized protein or clotting
factor found in blood. When a blood vessel is
injured, thrombin, another clotting factor, is
activated and changes fibrinogen to fibrin.

INR (International Normalized Ratio) blood test

that monitors whether the therapeutic or beneficial
effect of anticoagulation is within normal range,
usually between 2.0 and 3.0. It is calculated from the
prothrombin time (PT), or the time it takes for blood to
clot in a test tube.

Platelets Small particles in the blood that control

bleeding; they form clusters to plug small holes in
blood vessels and assist in the clotting process.

Thrombocytopenia A low platelet count.

Vitamin K A vitamin essential to the production of
the active forms of clotting factors II, VII, IX and X in
the liver.

ANTI PLATELETS DRUGS

MECHANISM OF ACTION

An antiplatelet drug is a member of a class of

drugs that decreases platelet aggregation and
inhibits thrombus formation.

Anti platelets drugs inhibits:

Inhibits cyclo-oxygenase and blocks the production of
thromboxane. (asprin)
inhibit the binding of adenosine diphosphate to its
platelet receptor and inhibit platelet aggregation by
blocking activation of the glycoprotein IIb/IIIa
pathway. (Clopidogrel)
Glycoprotein IIb/IIIa inhibitors (abciximab,
eptifibatide, and tirofiban) block the binding of
fibrinogen to glycoprotein IIb/IIIa receptors on the
platelet

INDICATIONS
1.
2.
2.

Prophylaxis of venous thrombosis.

Transient cerebral ischemic attacks.

Following coronary artery bypass grafting.

3.
4.

Prevention of myocardial infarction.

Following coronary artery angioplasty.

5.

Prosthetic heart valves.

DRUGS
Aspirin
Aspirin plus clopidogrel (Plavix)
Clopidogrel (Plavix)
Aggrastat
Persantine

NURSING CARE
Watch

for side effects: GI upset, nausea, vomiting, stomach pain

and loss of appetite. It is important to identify the presence of
these side effects since it might interfere with patient compliance.
also watch for dizziness, weakness,severe headache,blood in
urine or stool,nosebleeds, any unusual bleeding or bruising

Avoid

if possible IM or SQ injections. If unavoidable, apply

pressure to site for 5 minutes
Monitor

platelet count periodically

ANTICOAGULANT DRUGS

ANTICOAGULANT DRUGS
blood thinners
It lengthen the time takes for blood to clot, rather than
actually thinning the blood.
They inhibit clot formation by blocking the action of
clotting factors or platelets.
They are used to prevent blood clots
injected either into a vein or under the skin

MECHANISM OF ACTION
Activation of anticlotting factors (especially
antithrom bin III) e.g. HEPARIN
Direct inhibition of thrombin e.g. HIRUDIN
inhibition of synthesis of blood coagulation factor
precursors (zymogens) e.g. WARFARIN
Activated Protein C i.e., DROTRECOGIN ALFA

HEPRIN antidote = Protamine Sulphate

Warfarin antidote = Vitamin K

NURSING CARE
watch patient for bleeding: epistaxis, gum
bleeding, hemoptysis, hematuria, melena or
hemorrhage.
Heparin-induced thrombocytopenia
Laboratory monitoring typically includes
measurements of coagulations, such as
activated partial thromboplastin time (aPTT),
prothrombin time (PT),
plasma heparin concentration (antifactor
UFH Xa),
whole blood clotting time, activated clotting
time, plus a complete blood count (CBC) to
monitor platelets and assess for bleeding.

patients who will self-administer LMWH must be

instructed on correct subcutaneous
administration technique.
Foods containing vitamin K may
decrease anticoagulation and INR.
Monitor vital signs. (Increase in
heart rate accompanied by low blood
pressure or subnormal temperature may
signal bleeding.)

THROMBOLYTIC DRUGS

MECHANISM OF ACTION
Thrombolysis is the breakdown (lysis) of blood
clots by pharmacological means.
It works by stimulating fibrinolysis by plasmin
through infusion of analogs of tissue plasminogen
activator, the protein that normally activates
plasmin.

DRUGS
Streptokinase :
Indications ST elevation myocardial infarction.
Arterial thrombosis. Deep vein thrombosis.
Pulmonary embolism. Intra-arterial or
intravenous catheter occlusion.

t-PA
Indications ST elevation myocardial infarction.
Arterial thrombosis. Deep vein thrombosis.
Pulmonary embolism. Intra-arterial or
intravenous catheter occlusion.

ADVERSE EFFECTS
Major bleeding.
Cardiac arrhythmias.
Cholesterol embolus syndrome.
Anaphylactic reaction.
Cerebrovascular accident.
Intracranial hemorrhage.

STEPTOKINASE ADVERSE EFFECTS

Non-cardiogenic
Hypotension.
Fever

pulmonary edema.

and shivering.
History of cerebrovascular hemorrhage at any
time.
Non-hemorrhagic stroke or other
cerebrovascular event within the past year.
Marked hypertension ( reliably determined
systolic arterial pressure >180 mmHg and/or a
diastolic pressure >110 mmHg) at any time
during presentation.

Streptokinase Contraindication

trauma or surgery within 10 days, active internal bleeding

recent (within 2 months) stroke, intracranial or intraspinal
surgery

recent head trauma or known intracranial neoplasm

blood pressure > 200/ 120 mmHg (after pain relief)

pregnancy
use of Streptase is contraindicated in patients with streptococcal
infections

Dosage:
Acute Myocardial Infarct:1 500 000 IU with or without aspirin over 1 hour.
Administration should be commenced within 4-6 hours
after the onset of pain and within 1 hour of hospital
presentation.

Route:
IV
Dilution:

1 500 000 IU to be diluted in 100 mls of normal saline or

5% dextrose
infuse at a rate of 8 ml/hr

NURSING CARE

Acute myocardial infarction:

give ASAP after onset of symptoms.

insert 2 peripheral 16g cannulae

give aspirin 150 mg prior to streptokinase

record ECG pre and post streptakinase

1 500 000 IU diluted in 100 mls of normal saline or 5%

dextrose and given over 30-60 mins depending on the
patients reaction.

Continuous monitoring of ECG, and BP

Observe for reperfusion arrhythmias and bleeding