Drug Heparin Short half life Follow PTT

MOA Cofactor in activating AT III thrombin Xa

Clinical Immediate anticoagulation for PE, stroke, ACD, MI, DVT Can be used in pregnancy

Toxicity Bleeding HIT Osteoporosis Antidote: Protamine sulfate

Lepirudin Bivalirudin

Directly inhibit thrombin

Alternative to heparin in HIT

Warfarin Long half life Follow PT/INR

Interferes with -carboxylation of vit-k dependent clotting factors II, VII, IX, X, protein C and S.

Chronic anticoagulation in post STEMI, prophylaxis in venous thromboembolism Not used in pregnancy

Bleeding Teratogenic Skin / tissue necrosis Antidote: Fresh Frozen Plasma

Thrombolytic Streptokinase Urokinase tPA APSAC (Anistreplase)

Convert plasminogen plasmin which cleaves thrombin and fibrin clots PT & PTT No change in platelet count

Early MI Early ischemic stroke

Bleeding Contraindicated in active bleeding, history of intracranial bleeding, recent surgery, bleeding diathesis, sever hypertension Antidote: Aminocaproic acid inhibitor of fibrinolysis

Aspirin

Irreversibly inhibit COX-1,COX-2 prevent conversion of arachidonic acid to TXA2 bleeding time No effect on PT & PTT

Anti Pyretic Anti Analgesic Anti Platelet Anti Inflammatory

Gastric ulceration Bleeding Hyperventilation Reyes Syndrome Tinnitus Neutropenia ( Ticlopidin)

Clopidogrel Ticlopidine

Irreversible block ADP receptor prevent GP IIb/ IIIa expression inhibit platelet aggregation

ACS Coronary Stenting incidence or recurrence of thrombotic stroke

Cilostazol Dipyridamole

Inhibit PDE III cAMP in platelet inhibit platelet aggregation Vasodilator

Intermittent claudication Coronary vasodilation Angina prophylaxis Prevention of stroke or TIAs (combined with aspirin) ACS PTCA

Nausea Headache Facial Flushing Hypotension Abdominal pain Bleeding Thrombocytopenia

Abciximab

Monoclonal Ab bind to GP IIb/ IIIa on activated platelet inhibit aggregation