Anti-Coagulants &

Fibrinolytics
MACP 1213
 OBJEKT
IF
• Menerangkan tindakan ubat
anti-coagulants dan anti-
fybrinolytics.
• Menerangkan kesan
sampingan ubat.
• Menyatakan contoh, dos dan
cara pemberian ubat.
• Menyatakan indikasi dan
kontraindikasi ubat.
• Menyatakan nasihat yang
relevan semasa penggunaan/
pemberian ubat.
 Anti-
Coagulants
 Hemostasis
• Is a process that stops
bleeding in a blood vessels.
• A complex process that
involves ‘intrinsic & extrinsic
factors’.
• Activation of one factor will
enhance the next reaction.
• The net result is formation of
fibrin (insoluble protein).
 Thrombosis

• Formation of blood clot.

• May form in any vessel, artery
or vein when blood flow is
impeded.
 Embolism
• When thrombus detaches form
wall of blood vessel and
carried along by bloodstream it
is known as embolus.
• Embolism - When embolus
enter a smaller vessel it will
block the vessel.
 Anti-Coagulants
• Ubat yang digunakan untuk
menghalang pembentukan dan
pembesaran thrombus (blood
clot).
• Tidak berkesan terhadap
thrombus yang sudah
terbentuk.
 Contoh ubat

• Warfarin sodium
(Coumadin)
• Heparin
 1. Warfarin sodium
(Coumadin)
Category: B

• Coumarin derivatives.
• Anticoagulant oral yang sering
digunakan.
• Pilihan bagi pesakit dalam rawatan
anticoagulant untuk jangka
panjang.
 Tindakan warfarin

• Menganggu sintesis ‘vitamin-K

dependent clotting factors’ di
hati (FII-Prothrombin, FVII, FIX,
FX).
• Ini menyebabkan kekurangan
prothrombin.
• Maka pertukaran prothrombin
kepada thrombin akan
berkurang.
• Kekurangan thrombin pula
menyebabkan fibrinogen tidak
boleh ditukar kepada fibrin.
• Kekurangan fibrin pula akan
menghalang ‘blood clot’
 Indication
• Prevention & treatment of:
– Deep Vein Thrombosis (DVT)
– Pulmonary Embolism (PE)
– Atrial Fibrillation with
embolization
• Part of treatment of
Myocardial Infarction (MI)
 Dose
• Initial:
– 10mg/day PO (2-4 days)
• Maintenance:
– 2- 10mg/day PO
– Bergantung kepada INR
(diambil pada waktu yang
sama setiap hari)
 Kesan sampingan
• Internal organ bleeding
• Alopecia (gugur rambut)
• Nausea & Vomiting, Diarrhea
• Urticaria & Dermatitis
• Abdominal cramp
• Purple Toes
 Contraindication
• Allergic to warfarin
• Hemorrhagic disorders
• GI ulcer
• Hepatic & renal disease
• Pregnancy
• Lactation
• Blood Dyscrasias
Note: Use during pregnancy can cause fetal
death.
 Cautious
• Surgery
• Dental Extraction
• CHF
• Moderate to severe
hypertension
• Severe diabetes
 Interactions
• Herbal medicines
• Vitamin K rich vegetables
• Sulfonamide
• Rifampicin
• Carbamazepine
• Cimetidine
• Anti-fungal (azole)
• Metronidazole
• Co-trimoxazole
• Aspirin
• NSAIDs
• Erythromycin
• Urokinase
• Streptokinase
 2. Heparin
Category: B

• Tidak boleh diambil secara

oral (inactivated by gastric
acid in stomach).
• Perlu diberi secara suntikan.
 Tindakan heparin

• Menganggu pembentukan
‘fibrin clots’ dengan
menghalang pertukaran
prothrombin kepada thrombin
& fibrinogen kepada fibrin.
• Maka pertukaran prothrombin
kepada thrombin akan
berkurang.
• Kekurangan thrombin pula
menyebabkan fibrinogen tidak
boleh ditukar kepada fibrin.
• Kekurangan fibrin pula akan
menghalang ‘blood clot’
 Indication

• Prevention & treatment of:

– Deep Vein Thrombosis (DVT)
– Pulmonary Embolism (PE)
– Atrial Fibrillation with
embolization
• Part of treatment of
Myocardial Infarction (MI)
 Dose
• Adult:
– Initial: 5000 unit (IV inj)
– followed by continuous infusion
of 24000U-40000U over 24 hrs.
• Peads:
– Initial: 50 unit/kg (IV bolus)
– followed 1000 unit/kg IV q 4 hr
 Kesan sampingan

• Hemorrhage
• Alopecia (gugur rambut)
• Thrombocytopenia
• Urticaria
• Chills & fever
 Contraindication

• Allergic to heparin
• Hemorrhagic disorders
• Active bleeding
• Severe thrombocytopenia
• Blood dyscrasias
• Hemophilia
 Cautious

• Pregnancy
• Recent surgery / injury
• Woman > 60 yr
• Renal & Hepatic disease
 Interactions

• Aspirin
• Cefoperazone
• Dextran
• Urokinase
• Warfarin
 Soalan
1. Beri definisi Anti-coagulants?
2. Terangkan cara tindakan Anti-
coagulants?
3. Senaraikan ubat Anti-
coagulants?
4. Nyatakan kesan sampingan dan
kontraindikasi?
 Fibrinolytics
(Thrombolytics)
 Fibrinolytics
• Ubat yang digunakan untuk
menghancurkan/ menceraikan
‘blood clots’ yang sudah
terbentuk
• Reopen blood vessels after
they have been occluded.
 Contoh ubat

• Streptokinase (Streptase)
• Urokinase (Abbokinase)
 1. Streptokinase
(Streptase)
Category: A*

• Enzyme isolated from

streptococcal bacteria.
• Streptokinase boleh
menukarkan ‘endogenous
plasminogen’ kepada enzim
plasmin (fibrinolysin).
• Plasmin berupaya untuk
menguraikan ‘fibrin clot’.
 Indication

• Untuk memecahkan fibrin

clots:
– Acute MI
– PE
– DVT
 Dose
• Dos segera:
– Loading dose: 250000-600000
units dalam masa 30 minutes (IV
infusion)
– Maintenance: 100000 units/hr for
24-72 hr (depending on response)
• Dos Peads:
– Safety & Efficacy is not
established
 Kesan sampingan
• Internal bleeding
• External bleeding
• Allergic
• Rashes
• Fever
• Bronchospasm
 Contraindication

• Allergic to thrombolytics
• Recent intracranial/ intraspinal
surgery
• Active internal bleeding
• Severe uncontrolled
hypertension
 Cautious

• Recent major surgery

• Organ biopsy
• Serious GI bleeding
• Pregnancy
• Lactation
Interactions
• Aspirin
• Warfarin
 2. Urokinase
(Abbokinase)
Category: A

• Enzyme isolated from human

urin.
• Urokinase juga boleh
menukarkan ‘endogenous
plasminogen’ kepada enzim
plasmin (fibrinolysin).
• Plasmin berupaya untuk
menguraikan ‘fibrin clot’.
 Indication

• Untuk memecahkan fibrin

clots:
– Acute MI
– PE
– Thromboembolytics in the
eyes
 Dose
• Dos Adult:
– 4400U/kg over 10 min (IV
infusion)
– diikuti oleh 4400U/kg/hr for 12
hrs (IV infusion)
• Dos Peads:
– Safety & Efficacy is not
established
Kesan sampingan

• Internal bleeding
• External bleeding
• Bronchospasm
 Contraindication

• Allergic to thrombolytics
• Recent intracranial/
intraspinal surgery
• Active internal bleeding
 Cautious
• Recent major surgery
• Organ biopsy
• Serious GI bleeding
• Ulcerative wounds
• Pregnancy
• Lactation
Interactions
• Heparin
• Warfarin
 Soalan

1. Beri definisi Fibrinolytics?

2. Senaraikan ubat Fibrinolytics
beserta cara tindakan?
3. Nyatakan kesan sampingan dan
kontraindikasi ubat Fibrinolytics?