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  1. Vitamin K is DOC for warfarin overdose, aspirin poisoning (used with fresh frozen plasma and acts by increasing synthesis of factor 2, 7, 9, 10
  2. MC side effect of vitamn K is fluishing-(K3 MC used) K1,K3, CI in newborn due to hemolytic jaundice
  3. Warfarin is MC used oral anticoagulant, acts by inhibiting synthesis of factor 2, 7, 9, 10
  4. MC side effect is bleeding but also cause fat and breast necrosis which is more common in patients with protein C or proteins S deficiency
  5. Anticoagulants (both heparin and warfarin) cause osteopenia and osteoprosis because they inhibit carboxylation of protein osteonectin
  6. Heparins (hepa: greek-from liver-discovered by McLean) are of 3 types physiological (e.g. danapranoid), low molecular weight (Mol wt. <5000) e.g. enoxaparin, tinzaparin, dalteparin) and high molecular weight (mol. Wt > 10,000 eg. Hirudin).
  7. Heparin is CI in patients with active Tb, bleeding peptic ulcers, bleeding disorders, intracranial hemorrhage, ocular surgery, don’t do lumber puncture in heparinized patients
  8. MC side effect of heparins is bleeding; MC initial manifestation is hematuria; long term side effects include clotting, thrombocytopenia, osteoporosis, alopacia
  9. Heparin damages the platelets therefore the injured platelets clot together leading to formation of clot (white clot-as it is formed only by platelets)
  10. LMWH are better because of better pharmacokinetics, once a day daily dosing, less chance of bleeding or clotting leading to embolism
  11. DOC for heparin overdose is protomine sulphate, which is a basic LMWH heparin by itself (1mg-100 IU of heparin)
  12. Fibrolonytic inhibitors (also called as antiplasmin drugs) such as tranhexaenemic acid, epsilon amnocaproic acid, and iprotinin are used in massive bleeding
  13. Thrombolytic drugs such streptokinase (DOC for AMI) act by converting plasminogen to plasmin, which intern degrades clots
  14. MC side effect of streptomkinase is hypotension-antibodies can reduce its effectiveness
  15. Urokinase & t-PA are direct plasminogen activators (don’t evoke antibodies), anistrepplase is longest acting (1-2 hours), streptokinase (20 min) and alteplase, retiplase (<10 min)
  16. Bleeding is MC side effect-intracranial hemorrhage is most serious complication-they are contraindicated in-active bleed (e.g. ulcer)

Recent Advances = Newer Drugs

Sultroban (TxA2 antagonist)

Thromboembolic disorders/pulmonary hypertension

Oprelvekin (Hematopoietic stimulant )

Bone marrow suppression

Enoxaprin (Xa inhibitor; LMWH)


Argotroban (Thrombin inhibitor)

Heparin induced thrombocytopenia (HIT)

Cilostazole (antiplatelet)

Intermittent claudication )

Anagrelide (Antiplatelet)

Essential thrombocytopenia

Prasugrel (ADP antagonist)

Anti-platelet; prevention of thrombotic events


Nano iron particle; anemia in CRF

Romiplostim (Anti-hemorrhagic)


Dabigatran (Newer heparin)

Stroke reduction, embolism

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