Anti-platelets/Anti-coagulants
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What is aspirin used to treat - aside from pain?
CV disease (secondary prevention) Management of NSTEMI and STEMI MI Suspected/actual TIA Ischaemic stroke AF following disabling ischaemic stroke Following coronary bypass surgery
What are contra-indications to use of aspirin?
Active peptic ulceration Bleeding disorders Children under 16 (Reye's syndrome) Haemphilia History of hypersensitivity to aspirin or any other NSAID
Common side effects of aspirin?
Hypersensitivity N&V Tinnitus Post-prandial Pain/discomfort in stomach or lower chest Cough/asthma exacerbation
Indication for use of Warfarin?
VTE prophylaxis and treatment
What are the contra-indications of warfarin?
Avoid use within 24 hours post partum Haemorrhagic stroke Significant bleeding
What is the high level mechanism of action of Warfarin?
It is a Vitamin K Antagonist. Blocks the action of Vit K Slows down coagulation process
Vitamin K reduces manufacture of a number of factors involved in the clotting cascade. Which ones are affected?
VII, IX and X
What test is carried out to monitor warfarin levels?
INR International normalized ratio This is the prothrombin time
What does the INR test measure?
Time it takes for blood to clot and compares it to the average.
What is a normal INR for someone not on warfarin?
1.0
What does a high INR signify?
The higher the INR the longer the time it takes to clot
What is the full name of factor VII?
Proconvertin (Stable factor)
What is the full name of factor IX?
Antihaemophilic factor B Plasma thromboplastin component Christmas factor
What is full name of factor X?
Stuart-Prower factor
What is Thromboxane?
An eicosanoid involved in platelet plug formation
What are the two actions of Thromboxane?
Increases the ability of cells involved in clotting to stick together Makes blood vessels smaller by vasoconstriction
What two types of eicosanoids does aspirin affect?
It reduces levels of both Thromboxane and Prostacyclin
How does aspirin in 75mg dose lead to an anti-platelet effect?
Reduces both Thromboxane/Prostacyclin Prostacyclin can be made by endothelial cells whereas Thromboxane is made by platelets which have a 7-10 day lifespan so there is an anti-coagulant effect due to improved levels of prostacyclin at expense of thromboxane