Perfusion and Clotting Medications Overview

Feb 19, 2025

Notes on Perfusion/Clotting Medications Lecture

Overview

This lecture focuses on various medications relevant to perfusion and clotting, which are critical in managing cardiovascular health. Key medications discussed include anticoagulants, antiplatelets, thrombolytics, and other supporting drugs.

Anticoagulants

  • Purpose: Prevent the formation of new clots and the enlargement of existing clots.
  • Common Medications:
    • Heparin
    • Warfarin (Coumadin)
    • Direct Oral Anticoagulants (DOACs) like Dabigatran, Rivaroxaban, Apixaban
  • Mechanism of Action:
    • Heparin: Enhances antithrombin III activity
    • Warfarin: Inhibits vitamin K-dependent clotting factors
    • DOACs: Direct inhibition of thrombin or factor Xa
  • Monitoring:
    • Heparin: Activated Partial Thromboplastin Time (aPTT)
    • Warfarin: International Normalized Ratio (INR)

Antiplatelets

  • Purpose: Inhibit platelet aggregation to prevent arterial thrombosis.
  • Common Medications:
    • Aspirin
    • Clopidogrel (Plavix)
  • Mechanism of Action:
    • Aspirin: Inhibits cyclooxygenase, reducing thromboxane A2
    • Clopidogrel: Blocks the P2Y12 component of ADP receptors on the platelet surface

Thrombolytics

  • Purpose: Dissolve existing clots in acute situations (e.g., myocardial infarction, stroke).
  • Common Medications:
    • Alteplase (tPA)
  • Mechanism of Action:
    • Converts plasminogen to plasmin, which breaks down fibrin in clots
  • Considerations:
    • Strict inclusion criteria due to bleeding risk

Supporting Medications

  • Anti-fibrinolytics: Prevent breakdown of fibrin, e.g., Tranexamic acid
  • Vitamin K: Used to reverse the effects of Warfarin
  • Protamine sulfate: Used to reverse the effects of Heparin

Clinical Considerations

  • Patient Education:
    • Importance of adherence to medication regimen
    • Recognition of signs of bleeding
  • Drug Interactions:
    • Caution with NSAIDs and other blood-thinners
  • Renal and hepatic function:
    • Dose adjustments may be necessary

Conclusion

Understanding the pharmacology, indications, and special considerations of perfusion and clotting medications is essential for proper management of cardiovascular conditions and prevention of thrombotic events.