anti coagulants

Anticoagulants .

a)    Oral Anticoagulant: Vitamin K Antagonist: (Acenocoumarol).

In trade it is marketed as Acitorm (1/2/3/4 mg/-Abbott). Daily single dose as prophylaxis for VTE.

b) Coumarin Derivative: Warfarin

: Anticoagulant- Trade name Warf (CiThe various fractions of LMWH have different actions. There are 5 types of parental anticoagulants.e.g.- 1) LMWH( requires minimal monitoring, & less bleeding complications-so favored by ART specialists).2)  UFH, 3) Parnaparin 4) Reviparin Monitoring while on oral anticoagulants:-Warfarin sodium decreases all Vit K dependent coagulation factors like Factor II, VII, IX, X, Therefore women and men on long term Warfarin Ry  should be monitored by P.T.  Which is expressed as INR (International Normalized ratio)?.

Parenteral   Anticoagulants.

A).LMWH

A).LMWH:- a).Dalteparin, expressed as 5000 i.u. ---60 mg, Trade names are Inj. Fragmin, Inj. Beparine,( 5ml. vial-2500/- per vial 1ml per day,  Inj. Hibor(Elder).Rs. 420/-.Inj. Caprin multi-dose vial 5ml= 294/- therefore per day cost isAnticoagulant- Trade name Warf (Cipla) or Sofarin (Samarth) Daily single dose as prophylaxis for VTE.

Both LMWH and UFH do not cross placenta. Therefore both are not teratogenic.

A)              LMWH:-

Parenteral   Anticoagulants.

Both LMWH and UFH do not cross placenta. Therefore both are not teratogenic.

A)              LMWH:-

B)               The various fractions of LMWH have different action on factors like Factor II, VII, IX, X, Therefore women and men on long term Warfarin Ry  should be monitored by P.T.  Which is expressed as INR (International Normalized ratio)?.

The various fractions of LMWH have different actions -60 mg, Trade names are Inj. Fragmin, Inj. Beparine,( 5ml. vial-2500/- per vial 1ml per day,  Inj. Hibor(Elder).Rs. 420/-.Inj. Caprin multi-dose vial 5ml= 294/- therefore per day cost is 60/-Inj. Daltepin,  Daltehep.

                  b) Enoxaparin:- inj, Dose:- 5,000 i.u. (20-40 mg/day).

 Lonopin(Bharat Serum),Inj. Exhep( Emcure) 220/-, inj. LMWH(Nicholas)-0.4ml subcut, LMWX(Abbott);  CElAXANE(Sanofi).

DOSE:-a) PROPHYLACTIC   against VTE and RPL:-

b)   Therapeutic dose

Monitoring:-How & frequency ?

Action against overdosing:

Advantages of LMWH over UFH? Advantages of LMWH over UFH?

complications b) Bleeding complications are few in contrast to UFH. Does not alter P.Time and aPTT significantly. One can resort to Anti-Xa Assay 4 hours after last dose of LMWH in cases with renal failure and morbid obesity.

B),. Unfractionated Heparin. Brand Names:-This (UFH) is superior to LMWH in regard to aPL Syndrome. Each vial consists 25,000 i.u. per 5 ml. vial.,

a)               Inj Hep (Gland.  ),b)  Inj Rin (Samarth.)

DOSE:-Proph Dose:- 5,000 i.u. BD,

i)                  In cases with +ve serum markers for aPL, but negative for H/O VTE and negative for H/O Rec. abortion: - Aspirin & UFH 5000 i.u. BD or opt for aspirin & LMWH 40 mg/ day.

ii)                 

Therapeutic dose in PE or VTE:- The dose Therapeutic dose in PE or VTE:- The dose

Monitoring:- UFH can cause immune mediated thrombocytopenia, May add Calcium and Vit D to augment bone metabolism. Thrombocytopenia-.So it is mandatory to perform Platelate count after 2weks of initiation of UFH (5,000) preparations. If more than 6 months estimate BMD.

Dose:-

a) in prophylactic dose for prevention of further VTE and APL syndrome:-

b)               While patient on therapeutic dose ; aPTT(Activated Partial Thromboplastin Time). aPTT should be kept 1.5 to 2 times than normal.

Action against overdosing:-

A)LMWH    :-Dalteparin- Fragmin(Pfizer); Daltepin; Daltehep  Enoxaparin. Enoxarin, LMWX (Abbott); CElAXANE(Sanofi).

B)               UFH. C)               Parnaparin

D)              Reviparin

. Thrombolytic & Fibrinolytics Alteplase: used in MI patients.

E). Inj. Urokinase Proteolytic Enzyme & Thrombolytic

F).) Endogenous PLASMINOGEN activator & Thrombolytic Inj. Urokinase Proteolytic Enzyme & Thrombolytic Inj. Urokinase

                         Parenteral   Anticoagulants.

Anticoagulant	A)LMWH	Dalteparin	Fragmin(Pfizer); Daltepin; Daltehep	Fragmin 5,000 u=PFS Rs. 525/-
-do-	-do-	Enoxaparin.	Enoxarin, LMWX(Abbott);CElAXANE(Sanofi).
Heparin	B)Antithrombotic & Anticoagulant also		Hep(Gland); 5ml=25,000U=294/- Inj. Rin(Samarth)=25,000 u/ 5ml. = Rs 85/-
Parnaparin			Fluxum(USV)
Reviparin			Clivarine (Abbott)

D). Thrombolytic & Fibrinolytic: -- Alteplase: used in MI patients.

E). Inj. Urokinase Proteolytic Enzyme & Thrombolytic

F).) Endogenous PLASMINOGEN activator & Thrombolytic Inj. Urokinase Proteolytic Enzyme & Thrombolytic Inj. Urokinase Parenteral   Anticoagulants.

Anticoagulant	A)LMWH	Dalteparin	Fragmin(Pfizer); Daltepin; Daltehep	Fragmin 5,000 u=PFS Rs. 525/-
-do-	-do-	Enoxaparin.	Enoxarin, LMWX(Abbott);CElAXANE(Sanofi).

-do-	-do-	Enoxaparin.	Enoxarin, LMWX(Abbott);CElAXANE(Sanofi).
Heparin	B)Antithrombotic & Anticoagulant also		Hep(Gland); 5ml=25,000U=294/- Inj. Rin(Samarth)=25,000 u/ 5ml. = Rs 85/-
Parnaparin			Fluxum(USV)
Reviparin			Clivarine (Abbott)

C) Thrombolytic:- 

Thrombolytic & Fibrinolytics	Alteplase	Tr. of MI & PE, Stroke.
D) Endogenous PLASMINOGEN activator & Thrombolytic	INJ. Streptokinase	Tr of Acute MI &  PE
E) Proteolytic Enzyme & Thrombolytic	Inj. Urokinase	Peripheral arterial Thrombosis	Cath Lab, clearing catheters.	Tr of VTE

·                   LMWH. A) Dalteparin:- (5000 i.u.)-Fragmin,

·                   B) Enoxaparin:-Inj. Lonopin 600 mg. ,PFS, Bharat serum (Rs.557/-)

·                   Unfractionated Heparin.

Anticoagulant

A)LMWH

Dalteparin

Fragmin(Pfizer); Daltepin; Daltehep

Fragmin 5,000 u=PFS Rs. 525/-

·                    

Anticoagulant	A)LMWH	Dalteparin	Fragmin(Pfizer); Daltepin; Daltehep
-do-	-do-	Enoxaparin.	Enoxarin, LMWX(Abbott);CElAXANE(Sanofi).