Skip to main content

Anticoagulants





For more about heparin (enhances antithrombin activity) and warfarin (inhibits production of vitamin-K dependent clotting factors and anticoagulant proteins C & S), see their individual posts.

Factor Xa Inhibitors

Fondaparinux is a synthetic pentasaccharide that inhibits factor Xa. The other factor Xa inhibitors end in "xaban" and include rivaroxaban, apixaban, and edoxaban.

Thrombin Inhibitors

Direct thrombin inhibitors include argatroban, hirudin, and lepirudin.


Comments

Post a Comment

Popular posts from this blog

Chronic Myeloid Leukemia (CML)

Quick Review Patient is often older, and can no symptoms or have B symptoms (night sweats, etc), fatigue, and weight loss (caused by early satiety due to enlarged spleen). On physical exam, an enlarged spleen can be palpated. CBC shows very high WBC count (typically >100,000) with elevated basophils on differential. Peripheral smear shows early, immature neutrophil precursors (myelocytes, metamyelocytes) as well as many basophils. It is important for CML to know the details of the genetic abnormality because it relates to the treatment. CML is due to a translocation of BCR and ABL on chromosomes 9 and 22 resulting a fusion BCR-ABL gene that produces a tyrosine kinase that is always active. The treatment of choice is a tyrosine kinase inhibitor e.g. imatinib. They work to suppress the tyrosine kinase and can induce disease remission. Relevant Images Immature neutrophil precursors on peripheral smear BCR-ABL translocation
7 comments
Read more

Chemotherapy

Terminology Adjuvant therapy - given in addition to standard therapy Consolidation therapy - given after induction therapy with multidrug regimens to further reduce tumor burden Induction therapy - initial dose of treatment to rapidly kill tumor cells and send the patient into remission Maintenance therapy - given after induction and consolidation therapies or after the initial standard therapy to kill any residual tumor cells and keep the patient in remission Neoadjuvant therapy - given before the standard therapy for a particular disease Remission - less than 5% tumor burden Salvage therapy - given when standard therapy fails Adjuvant therapies in various cancers Metastasis to bone - bisphosphonates (e.g. zoledronic acid) are given to prevent lytic lesions and pathologic fractures as well as malignant hypercalcemia. Bisphosphonates work by inhibiting osteoclasts and thereby preventing bone breakdown. Breast cancer Tamoxifen , a selective estrogen recep...
13 comments
Read more

Coagulation Disorders

Coagulation Cascade To understand the coagulation disorders, an understanding of the coagulation cascade is necessary. The coagulation cascade consists of an extrinsic and intrinsic pathway both of which end in a common pathway. The extrinsic pathway begins when damaged tissue releases thromboplastin. Thromboplastin activates factor VII and the activated factor VII then activates factors IX and X. The intrinsic pathway begins when exposure to subendothelial collagen or exposure to high molecular weight kininogen (HMWK) activates factor XII which is also known as Hageman factor. The activated factor XII then activates factor XI which goes on to activate factor X. Activated factor IX needs to be in a complex with activated factor VIII, platelet factor 3 (PF3) and calcium. Calcium is needed to bind the activated coagulation factor. The common pathway begins with activated factor X which can be arrived at by either the intrinsic or extrinsic pathways. Activated factor X forms a comp...
2 comments
Read more