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Pro-Coagulants

 

  1. Vitamin K
    Most commonly used coagualant clinically
    1. Vitamin K is naphthaquinone derivative.
    2. Three types
      1. K1-Phytoquinone (plant derives-used clinically)
      2. K2-Menaquinone (Endogenous, bacterial)
      3. K3- has two parts: Water soluble & lipid soluble

MAO

Increases synthesis of II, VII, IX, X (Stimulates gamma carboxylation in liver)

Has latency in onset of action


P/k

  • Short acting drug, half life 1 hour

Uses:

i.    Warfarin overdose (DOC)            ii.  Aspirin overdose          iii.  Alcohol liver disease

iv.  Obstructive jaundice                    v.  Hemorrhagic disease of Newborn                                                                         

vi.  Malabsorption syndrome

vii. Broad spectrum antibiotic use

 

Side effects

  1. Flushing
  2. Chest pain
  3. Hypotension
  1. Cryoprecipitate
    Cryoprecipitate is a plasma protein fraction obtainable from whole blood.
    It is used to treat deficiencies or qualitative abnormalities of fibrinogen, such as that which occurs with disseminated intravascular coagulation and liver disease.
    A single unit of cryoprecipitate contains 300 mg of fibrinogen. 
  2. Fibrin0lytic Inhibitors
  • ε Aminocaproic acid (EACA), which is chemically similar to the amino acid lysine, is a synthetic inhibitor of fibrinolysis. It competitively inhibits plasminogen activation. Tranexamic acid is an analog of aminocaproic acid and has the same properties.

Uses:

  1. Adjunctive therapy in hemophilia, as therapy for bleeding from fibrinolytic therapy,
  2. Prophylaxis for rebleeding from intracranial aneurysms.
  3. Postsurgical gastrointestinal bleeding, varices, post-prostatectomy bleeding and bladder hemorrhage secondary to radiation and drug-induced cystitis.

Other pro-coagulants

  1. Antithrombin                                
  2. Fibrinogen                   
  3. Anti-hemophilic globulin              
  4. Cryoprecipitates                  
  5. Plasma concentrates                            
  6. Lyophilized VIII concentrates

DEFICIENCY STATE (FACTOR)

TREATMENT/REPLACEMENT

 I. Hypofibrinogenemia

Cryoprecipitate FFP

II.  Prothrombin deficiency

 

Prothrombin complex concentrates (intermediate purity factor IX concentrates)

V. Factor V deficiency

FFP

VII. Factor VII deficiency

 

FFP

Prothrombin complex concentrates (intermediate purity factor IX concentrates)

Recombinant factor VIIa

VIII. Hemophilia A

 

Recombinant factor VIII products

Plasma-derived high purity concentrates Cryoprecipitate

Some patients with mild deficiency will respond to DDAVP

IX. Hemophilia B

 

Recombinant factor IX products Plasma-derived high purity concentrates

X. Stuart-Prower defect

 

FFP

Prothrombin complex concentrates

XI. Hemophilia C

FFP

von Willebrand disease

 

Intermediate purity factor VIII concentrates that contain von Willebrand factor

Some patients respond to DDAVP

Cryoprecipitate

XIII. Factor XIII deficiency

 

FFP

Cryoprecipitate

 

 

 





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