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Anticoagulants and Thrombolytics - Coggle Diagram

- - - - Antithrombin III
        Protein C
        S tissue facyor pathway inhibitor
- - - - Bivalirudin
      - Argatroban
      - Dabigatran
      - Lepirudin
    - - Heparin
        LMWH: Enoxaparin
    - - Warfarin
    - - ApiXaban
      - RivaroXaban
      - Fondaprinux
  - - - Warfarin
      - NOACs / DOACs
        
        Dabigatran
        
        ApiXaban
        
        RivaroXaban
    - - Heparin
      - Lepirudin
      - Bivalirudin
      - Fondaprinux
      - Argatroban
- - - - Indications
        
        High risk of bleeding - can stop administration quickly by stopping infusion
        Renal failure - LMWH is renally cleared
    - - Enoxaparin
        
        Longer DOA
      - Poor Thrombin inhibitor
        Mainly Factor Xa actions
      - Prefered over UF heparin
        
        Greater bioavailabilty (90% vs 30%)
        No sturation clearnace kinetcis
        Predictable dose effects
        Less monitoring
  - - - Polycationic protein combines negatively charged heprin
- - - - Competition with other plasma bound drugs
        Displace warfarin, transient effect more free warfarin
        Sedatives
        NSAIDs
      - Broad Spectrum antiobiotics
        Suppress vit K production by gut flora
      - CYP450 decreasing drugs
        Antiotics
        Erythromycin
        Cimetidine (H2 antagonist)
        Omeprazole (PPI)
        Fluconazole (Anti-fungal)
        Amiodarone (C III antiarrythmic
      - Antiplatelet agents
      - Cranbarry juice
        Alcohol
    - - CYP450 inducers
        Barbiturates (sedatives)
        Antiepileptic agent phenytoin
        Rifampicin (antibacterial)
        CArbamazepine (anticonvulsant)
      - Cholestyramine - Bile acid sequesterant
      - Herbal medicine - St John's Wort
      - Vit K supplements / food
- - - - Reversible Thrombin Inhibitor prevents conversion of fibrinogen to fibrin
      - Reduced formation of fibrin
        
        Reduced thrombin-stimulates platelet aggregation
        
        Prevents thrombus development
  - - - Factor Xa inhibitors
      - Bind directly and irreversibly to active site of F Xa
        
        Block interaction of Xa with Va
        
        Prevent formation of complex with prothrombin
        
        Thrombin cannot be generated
        No conversion of fibrinogen to fibrin for clot formation