Binds to & enhances anti-thrombin, which then inhibits clotting factors (IIa, IXa, Xa). Heparin is then released for renewed binding to more anti-thrombin.

bleeding, loss of hair (reversible alopecia), osteoporosis, mineralocorticoid deficiency,

heparin-induced thrombocytopenia (systemic hypercoagulable state), allergic reactions

CI: bleeding issues (hemophilia, hypertension), infective endocarditis, active TB, visceral carcinoma, advanced hepatic/renal disease

Inhibit activated factor X but have less effect on thrombin than HMW

Equal efficacy but increased bioavailability = less frequent dosing requirements

“

Osteoporosis, thrombocytopenia

thromboembolism

Binds antithrombin with high specific affinity resulting in efficient inactivation of factor Xa

Does not cross-react with heparin-induced thrombocytopenia (HIT) antibodies in most people

Thromboembolism

Long half-life (1/day dosage)

Bivalent DTIs that bind at both the catalytic or active site of thrombin as well as at a substrate recognition site

Excreted by kidney

Up to 40% of patients who receive long-term infusions develop antibody against thrombin-lepirudin complex

Rx: HIT, coronary angioplasty

in patients w. HIT

CI: renal insufficiency

Preferred for patients with hepatic insufficiency

Small molecules that bind only at the thrombin active site

Clearance by liver

Rx: HIT, coronary angioplasty

in patients w. HIT

CI: hepatic insufficiency

Preferred for patients with renal insufficiency

Blocks the γ-carboxylation of glutamate residues in prothrombin and factors VII, IX, and X as well as anticoagulant proteins C and S.  => incomplete coagulation factor molecules that are biologically inactive.

Protein carboxylation is coupled to oxidation of vitamin K.  Warfarin prevents reductive metabolism of the inactive vitamin K back to its active form.

CI: pregnancy (crosses placenta

and can cause hemorrhage or

abnormal bone formation in fetus)

Drug Interactions:

Synergistic effects with aspirin pyrazolones, metronidazole & trimethoprim

Competitive antagonism with

barbiturates & rifampin

By interfering with the

synthesis of clotting factors,

coumarin anticoagulants take

longer until the onset of effects.

Protein synthesized by streptococci that combines with the proactivator plasminogen forming an enzymatic complex that catalyzes conversion of plasminogen to plasmin

Patients with antistreptococcal antibodies can develop fever, allergic reactions, and resistance

↑ bleeding risk in ischemic stroke

Pulmonary embolism

Deep venous thrombosis

Ascending thrombophlebitis Peripheral vascular disease

Acute MI

Enzyme synthesized by the kidney that directly converts plasminogen to active plasmin

“

Activates plasminogen  that is bound to fibrin, which (theoretically) confines fibrinolysis to formed thrombi and avoids systemic activation

“ + acute ischemic stroke

recombinant form of activated protein C, which inhibits factors Va and VIIIa; anti-thrombotic, anti-inflammatory, and profibrinolytic properties

bleeding

Sever sepsis or septic shock

(but efficacy is now questionable)

Irreversibly block the ADP receptor on platelets, inhibiting ADP induced platelet aggregation

hemorrhage, leukopenia, purpura

Agranulocytosis,

blood dyscrasias

Clopidogrel has ↓ neutropenia

Prevention of vascular events among patients with transient ischemic attacks, strokes, and angina pectoris

Irreversibly block the ADP receptor on platelets, inhibiting ADP induced platelet aggregation

hemorrhage, leukopenia, purpura

Agranulocytosis,

blood dyscrasias

Clopidogrel has ↓ neutropenia

Prevention of vascular events among patients with transient ischemic attacks, strokes, and angina pectoris

Inhibits glycoprotein IIb/IIIa receptor. This glycoprotein acts as the final common pathway for platelet aggregation. It is normally activated by fibronectin,

vitronectin, fibrinogen & vWF

Thrombocytopenia

Percutaneous coronary

interventions, acute coronary

syndrome

Inhibits glycoprotein IIb/IIIa receptor

Thrombocytopenia

Percutaneous coronary interventions, acute coronary

syndrome

Inhibits glycoprotein IIb/IIIa receptor

Thrombocytopenia

Percutaneous coronary interventions, acute coronary

syndrome

Vasodilator; ↓ platelet function by inhibiting adenosine uptake and cGMP phosphodiesterase activity

Little or no beneficial effect on its own

prevent cerebrovascular ischemia (w/aspirin), thromboembolis with prosthetic heart valves (w/ warfarin)

Phosphodiesterase inhibitor that promotes vasodilation and inhibition of platelet aggregation

Rx: intermittent claudication

(leg cramp w/ exercise d/t

arterial obstruction)

cAMP-PDE-III inhibitor that inhibits megakaryocyte maturation into platelets

Hepatic toxicity, CVA, hemorrhage

Essential thrombocytosis (overproduction of platelets); chronic myeloid leukemia

Inhibits fibrinolysis by inhibiting

plasminogen activation

Rx: adjunctive therapy in

hemophilia, or as a prophylaxis

for re-bleeding from

intracranial aneurysms

Serine protease inhibitor that inhibits fibrinolysis by free plasmin. Inhibits the

plasmin-streptokinase complex

↑ risk of renal failure, heart attack, and stroke

Reduce bleeding from surgery