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Questions and Answers
What is the target of Vorapaxar in its anti-platelet action?
What is the target of Vorapaxar in its anti-platelet action?
- PAR-1 receptor (correct)
- GPIIb/IIIa receptor
- P2Y receptor
- Thrombin receptor
Which of the following medications is a fibrinolytic medication used to treat acute thrombotic events such as deep vein thrombosis?
Which of the following medications is a fibrinolytic medication used to treat acute thrombotic events such as deep vein thrombosis?
- Aspirin
- Clopidogrel
- Ticagrelor
- Streptokinase (correct)
What is the primary mechanism of action of Dipyradimole in its anti-platelet action?
What is the primary mechanism of action of Dipyradimole in its anti-platelet action?
- Inhibition of phosphodiesterase (correct)
- Inhibition of COX1 enzyme
- Antagonism of TXA2 receptors
- Blockade of P2Y receptors
Which of the following is NOT an anti-platelet medication?
Which of the following is NOT an anti-platelet medication?
What is the end result of the fibrinolytic pathway?
What is the end result of the fibrinolytic pathway?
Which of the following anti-platelet medications targets the GPIIb/IIIa receptor?
Which of the following anti-platelet medications targets the GPIIb/IIIa receptor?
Which of the following is a recombinant tPA used to treat acute ischemic stroke?
Which of the following is a recombinant tPA used to treat acute ischemic stroke?
What is the relationship between coagulation and fibrinolysis?
What is the relationship between coagulation and fibrinolysis?
Which of the following medications is a direct inhibitor of Factor Xa, commonly used for atrial fibrillation, DVT, and pulmonary embolism?
Which of the following medications is a direct inhibitor of Factor Xa, commonly used for atrial fibrillation, DVT, and pulmonary embolism?
Which of the following is a major concern associated with warfarin use?
Which of the following is a major concern associated with warfarin use?
What is the mechanism of action of heparin, a commonly used anticoagulant?
What is the mechanism of action of heparin, a commonly used anticoagulant?
Which of the following is NOT a characteristic of fondaparinux, a type of heparin?
Which of the following is NOT a characteristic of fondaparinux, a type of heparin?
Which of the following is an antidote for dabigatran, a direct thrombin inhibitor?
Which of the following is an antidote for dabigatran, a direct thrombin inhibitor?
Which of the following medications is NOT considered an anticoagulant?
Which of the following medications is NOT considered an anticoagulant?
Which of these antithrombotic drugs inhibits the amplification of thrombus formation by restricting platelet activation?
Which of these antithrombotic drugs inhibits the amplification of thrombus formation by restricting platelet activation?
What is the key role of thrombin in the coagulation cascade?
What is the key role of thrombin in the coagulation cascade?
Which of the following conditions is NOT a major cause of thrombosis?
Which of the following conditions is NOT a major cause of thrombosis?
Which of the following statements is TRUE regarding the extrinsic pathway of coagulation?
Which of the following statements is TRUE regarding the extrinsic pathway of coagulation?
Which of the following drugs would be MOST effective in dissolving an existing blood clot?
Which of the following drugs would be MOST effective in dissolving an existing blood clot?
What is the physiological role of glycoprotein IIb/IIIa receptors on platelets?
What is the physiological role of glycoprotein IIb/IIIa receptors on platelets?
What is the main mechanism of action of anti-platelet drugs?
What is the main mechanism of action of anti-platelet drugs?
A patient with a history of atrial fibrillation is prescribed warfarin for stroke prevention. What is the target INR range for this patient?
A patient with a history of atrial fibrillation is prescribed warfarin for stroke prevention. What is the target INR range for this patient?
What is the main difference between venous thrombi and arterial thrombi?
What is the main difference between venous thrombi and arterial thrombi?
Which of the following is a potential complication of using antithrombotic drugs?
Which of the following is a potential complication of using antithrombotic drugs?
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Study Notes
Thrombosis
- Venous thrombi are characterized by high fibrin content, while arterial thrombi are high in platelets
- Major causes of thrombosis include:
- Myocardial infarction
- Atherosclerosis
- Vasculitis
- Hypertension
- Smoking
- Radiation
- Chemical irritation
- Inflammation
- Hypoxia
- Infection
Coagulation Pathway
- Intrinsic pathway involves factors XII, XI, and IX
- Extrinsic pathway involves tissue damage or contact with external bodies, leading to the conversion of prothrombin to thrombin (factor IIa)
- Antithrombin III regulates the coagulation process
Fibrin Formation
- Thrombin cleaves fibrinogen to form insoluble fibrin
- Fibrin strands assemble into fibrils that bind to platelets and each other
Platelet Aggregation
- Activated platelets express glycoprotein IIb/IIIa receptors, which bind to fibrinogen and collagen
- Release of thromboxane A2 (TXA2) and adenosine diphosphate (ADP) promotes platelet activation
Antithrombosis Drugs and Strategies
- Anticoagulants inhibit initiation of thrombin formation
- Anti-platelet drugs inhibit platelet activation
- Fibrinolytics promote degradation of fibrin strands
International Normalised Ratio (INR)
- Prothrombin time measures blood clotting time (normal range: 12-13 seconds)
- INR compares prothrombin time to a standardized norm
- Therapeutic INR ranges:
- Normal healthy: 0.8-1.2
- Therapeutic: 2-3 or 2.5-3.5
- Dose reduction: 5-9
- Emergency: >8
Anticoagulants - Warfarin
- Warfarin is a vitamin K antagonist, the most commonly used anticoagulant in the UK
- Mechanism: inhibition of vitamin K-dependent clotting factors
Anti-Platelet Drugs
- Examples:
- Clopidogrel
- Prasugrel
- Ticagrelor
- Aspirin
- Mechanisms:
- Inhibition of ADP receptors
- Inhibition of thromboxane A2 synthesis
- Inhibition of glycoprotein IIb/IIIa receptors
Fibrinolytics (Thrombolytics)
- Examples:
- tPA ( alteplase)
- Streptokinase
- Tranexamic acid
- Mechanism: degradation of fibrin strands
- Indications:
- Acute thrombotic or embolic events
- Deep vein thrombosis
- Post-myocardial infarction
Fibrinolytics
- Streptokinase is a bacterial plasminogen-activating enzyme
- Recombinant tPA (alteplase) is used for acute thrombotic or embolic events
- Tranexamic acid is used to inhibit fibrinolysis
Anticoagulants - Warfarin Alternatives
- Direct inhibitors of factor Xa (e.g. rivaroxaban, apixaban)
- Direct thrombin inhibitors (e.g. dabigatran)
- IV anticoagulants:
- Heparins (e.g. fondaparinux)
- Hirudins (e.g. lepirudin)
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