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PCol I - Final Exam

blood/anticoagulants/antiplatelet/thrombolytic drugs

red thrombus venous thrombosis --> usually due to blood stasis; has low platelet and high fibrin content
white thrombus arterial thrombosis --> associated w/atherosclerosis; high platelet and low fibrin content
substance located in the subendothelial matrix that activates platelets when blood comes into contact with it in instances of vascular injury collagen
extrinsic pathway requires what tissue factor (something outside of blood)
common pathway b/w extrinsic and intrinsic pathways Xa splits prothrombin into thrombin (factor V, PL, Ca present)
prothrombin time (PT) time required for plasma to clot when exogenous tissue factor is added
fibrin digesting enzyme responsible for thrombolysis plasmin (activated by t-PA from plasminogen)
converts fibrinogen to fibrin thrombin
helps solidify platelet plugs to patch up small holes, insoluble fibrin
vitamin K dependent factors (4) II, VII, IX, X (2, 7, 9, 10) - synthesized in the liver; required for clotting cascades
white thrombus generally responsible for for acute MI, stroke, etc; LDL usually involved
red thrombus generally responsible for Deep vein thrombosis (DVT) and pulmonary embolism
three potential causes for red thrombus vessel wall damage (hip/knee surgery), stasis, hypercoagulability
are antiplatelet drugs more effect for white thrombus or red thrombus related disorders white thrombus (atherosclerotosis related) disorders more responsive to antiplatelet drugs (aspirin)
heparin injectible anticoagulant; 5-50 kDa; accelerates antithrombin III (ATIII); inhibits thrombin (IIa) and Xa; requires PT monitoring - good for immediate relief
LMWH low-molecular weight heparins; 1-10 kDa; accelerates ATIII; inhibits Xa, but NOT thrombin; more predictable than heparin; doesn't require PT monitoring - good for home use
critical length for binding pocket in antithrombin III (ATIII) 5 units (highly acidic) - pentasaccharides
Fondaparinux heparin derivative for prevention/treatment of VTE; once daily, predictable; doesn't bind platelets (no heparin-induced thrombocytopenia)
direct thrombin inhibitors - parenteral(3) Hirudin – irreversible binds to thrombin; Bivalirudin – analog of hirudin; Argatroban – non-covalent reversible binding
direct thrombin inhibitors - oral (1) Ximelagatran - non-covalent reversible binding, first oral form.
only FDA approved oral anticoagulant in US warfarin - vitamin K antagonist
warfarin MOA interferes w/synthesis of factors II, VII, IX, X, but their half-life is 8 - 60 hours so requires bridge therapy; target INR 2 - 3; initial PT changes due to depletion of factor 7, but takes a few weeks to turn over factor 10
Created by: Krafty