Blood

1) What are the differences between Traditional heparin and LMWT?

• Traditional heparin high molecular weight, inhibits activated
clotting factors mainly thrombin (factor IIa) and Xa.
• Require monitoring activated partial thromboplastin time (aPTT).
• LMWT low molecular weight heparin, derived from degradation of
UFH , Have equal efficacy, without frequent laboratory monitoring
(suitable for outpatient therapy)
• Have a more predictable anticoagulant response (better
bioavailability, longer t 1/2)
• Binding to platelets and osteoblasts is reduced with LMWH
compared with UFH
• LMWHs increase the action of antithrombin III on factor Xa but
not on thrombin. Not factor II
2) Mention the Antidote of heparin and warfarin in overdose of each one?
And the mechanism of these antagonism.
Antidote of heparin: protamine sulfate
mechanism of these antagonism: Heparin is strongly acidic and is
neutralized by IV protamine sulfate (a strongly basic protein) antidot
Antidote of warfarin: Vit K
↑ synthesis of clotting factors
3) What are the Side effect of heparin? Bleeding, Allergic reactions,
osteoporosis, thrombocytopenia(HIT).
4) What are the Side effect of warfarin? Bleeding, Teratogenic(fetal
Warfarin syndrome), Catastrophic thrombosis if suddenly stopped,
Drug interaction, Hemorrhagic disorder in the fetus, Skin necrosis and
Dermatitis, Alopecia.
5) What are drugs which ↑ anticoagulant action of warfarin?
1) Drugs ↑ Warfarin blood level
A) Drugs displace warfarin from plasma protein: Aspirin,
sulphonamide
b) Microsomal enzyme inhibitors: ↓ metabolism of Warfarin:
Cimetidine, erythromycin, quinolone
2) Drugs ↓Vit K
a) ↓vitamin K synthesis by gut flora: oral antibiotics
b) ↓vitamin K absorption: Liquid paraffin (Laxative)
3) Drugs ↓other clotting factors: Anabolic steroids, thyroxin
hormone
6) What are drugs which ↓ anticoagulant action of warfarin?
1 -Drugs ↓ Warfarin blood level
a- Drugs ↓its absorption → Cholestyramine or aluminum hydroxide
b- Microsomal enzyme inducers → ↑metabolism of Warfarin → e.g.
phenobarbitone
2 -Drugs ↑Vit K
↑Intake of Vit K & oral contraceptives → ↑ synthesis of clotting
factors
3- Drugs ↑other clotting factors: Giving clotting factors alone, fresh
frozen plasma or fresh blood

7) Mention the indication or use of direct thrombin inhibitor.

Argatroban(parenteral): Alternative to heparin especially if heparin
caused thrombocytopenia, Thromboembolic disorder
Dabigatran(orally): to prevent clots that can be caused by atrial
fibrillation.
8) Mention the Mechanism of warfarin and heparin as anticoagulants.
Heparin: Indirect Thrombin Inhibitor → by increasing the activity of the
endogenous anticoagulant “antithrombin III” (1000 folds) which inhibits
activated clotting factors mainly thrombin (factor IIa) and Xa.
Warfarin: Inhibits synthesis of Vitamin K-dependent coagulation factors
II, VII, IX, & X through inhibition of Vit. K epioxide reductase enzyme.
9) Mention the Mechanism of aspirin, clopidogrel and Abciximab as
antiplatelets
Aspirin in low dose: inhibits thromboxane synthesis by inhibit COX
enzyme irreversibly and thus results in decreased synthesis of TXA2
leading to anti-aggregatory effects.
Clopidogrel: acts as irreversible antagonists of ADP receptor.
Abciximab: monoclonal antibody against Gp IIb/IIIa receptor , blocks
binding of platelets to fibrinogen.

10) Why aspirin is given in low dose not in large dose as antiplatelets?
Aspirin in small dose inhibits thromboxane synthesis but does not inhibit
prostacyclin synthesis .
For antiplatelet action lowest doses of aspirin are required (75-3oo mg).
11) What is the precaution of use aspirin during elective dental operation?
• to be cautious about the potential for increased bleeding due to
aspirin's blood-thinning effects.
• Dentists may advise patients to temporarily stop taking aspirin
before the procedure to reduce the risk of excessive bleeding during
and after the operation.
• is important to consult with a healthcare professional before making
any changes to medication regimens.
12) Mention the main differences between Heparin and Warfarin
Heparin Warfarin
administered by IV or SC injection Administered orally
Mechanism of action: increasing the Mechanism of action: Inhibits synthesis of
activity of antithrombin III inhibits Xa, IIa Vitamin K-dependent coagulation factors
II, VII, IX, & X through inhibition of Vit.
K epioxide reductase enzyme
Safe as anticoagulant during pregnancy Not Safe as anticoagulant during
pregnancy cause Teratogenic (fetal
Warfarin syndrome)
does not cross the placenta cross the placenta
rapid onset of action Slow onset of action
immediate anticoagulation Delay effect 3-4 days until effect is
seen
short duration Long duration
protamine sulfate is antidot Vit K is antidot
not absorbed from the GIT Good absorption Bioavailability
100% • 98%

13) Pharmacological basis underling use of aspirin as antiplatelets

Using Aspirin in small dose as antiplatelet because inhibits thromboxane
synthesis but does not inhibit prostacyclin synthesis . inhibits COX enzyme
irreversibly and thus results in decreased synthesis of TXA2 leading to
anti-aggregatory effects.
For antiplatelet action lowest doses of aspirin are required (75-3oo mg).
Aspirin in normal dose at higher doses (> 325 mg/day) use as analgesics for
pain, inflammation and fever as other NSAIDS.