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KELOMPOK 3

1. AZKIA FITRI (1700007)


2. DESYA WINANTI (1700009)
3. ELSA FITRI RAMADHANI (1700011)
4. FAMELLA YUSTIKA RISKI (1700013)
5. HAVIZ ARFANSYAH (1700018)
6. LISMARIANTI (1700023)
7. SILVIA LORENSA (1700035)
8. VALENTINA FITRI (1700039)
9. YORI YUNITA SINULINGGA (1700041)
ANTI COAGULANT, ANTI PLATELET,
DAN TROMBOLITIK
Anticoagulants are to prevent thrombus
formation or break down thrombus that has
fonrmed o the side fibrin tissue with platelets and
red blood cells. Anticoagulants are numerous in the
context and treatment of deep vein thrombosis in
the legs. Anticoagulants are less useful in preventing
thrombus formation in the arteries, for more
specialized thrombi in blood vessels, which only
consist of platelets with little fibrin.
1. ANTICOAGULANT

ORAL PARENTERAL
ORAL
1. Vitamin K antagonists (VKAs) such as warfarin function by
blocking the vitamin K epoxide reductase, which causes
initial pro-thrombotic effects, by initially blocking proteins C
and S.
Drug example :
NATRIUM WARFARIN
 Indication: embolization prophylaxis in rheumatic heart
disease and atrial fibrillation; prophylaxis after the
installation of a prosthetic heart valve; prophylaxis and
treatment of venous thrombosis and pulmonary embolism;
transient cerebral ischemic attack.
 Warning: liver and kidney disorders, have just undergone
surgery, breastfeeding, avoid cranberry juice.
 Contraindications: pregnancy, peptic ulcer, severe
hypertension, bacterial endocarditis.
 Side effects: bleeding; hypersensitivity, skin rash, alopecia,
diarrhea, decreased hematocrit, skin necrosis, purple toes,
jaundice, liver dysfunction; nausea, vomiting, pancreatitis.
 Dose: The provision of warfarin must be measured based on
the determination of the "prothrombin time" quick onestage
or thrombotest. The usual level of support for anticougulant
therapy is 2 times greater or smaller than the normal quick
one-stage prothrombin time or 15-30% normal value in
"converted cougulation activity" or approximately 10% of
the normal thrombotest.
The usual dosage for adults is 10 mg daily for
2 to 4 days with daily adjustments based on the
results of prothrombin time, advanced therapy with
a support dose of 2-10 mg once daily. Because
sensitivity to drugs is very individualistic, it can
change, prothombin time determination must be
carried out periodically, especially at the beginning
of therapy so that patient kougulasi activities are in
the therapeutic range.
 Trade name : simarc,notisil 2,and notisil 5.
2. These drugs inhibit factor Xa, the first step in the
common pathway, either directly or indirectly. The
inhibition occurs in a dose-dependent manner.
 Apixaban and rivaroxiban, directly bind to the active
site of factor Xa, thereby inhibiting both free and clot-
associated factor Xa. These drugs also inhibit
prothrombinase activity.
Drug example :
APIXABAN
 Indication: prevention of venous thromboembolic events
(VTE) in adult patients after hip or knee replacement
surgery.
 Warning: risk of bleeding, kidney damage, mild and moderate
liver damage, neuraxial anesthesia, fractured hip surgery,
gastrointestinal ulcers, history of hemorrhagic strokes, severe
hypertension, endocarditis infection, postoperative brain,
spinal cord, or eyes, using drugs that increase the risk of
bleeding, use is not recommended in pregnancy and lactation.
 Contraindications: active bleeding, coagulopathy-related liver
disease and other risks of bleeding.
 Side effects: general: anemia, bleeding, bruising, and nausea;
Unusual: hypotension, thrombocytopenia, epistaxis,
gastrointestinal bleeding, anal bleeding (hematozesia),
increased transaminases, increased aspartate
aminotransferase, increased gamma-glutamyl transferase,
impaired liver function test results, increased blood alkaline
phosphatase, increased blood bilirubin, hematuria
 Dose: oral, 2.5 mg twice daily, given 12-24 hours
after surgery. Treatment is done for 10-14 days for
post knee replacement surgery or 32-38 days for
post hip replacement surgery.
 Trade name : eliquis (injection)
2. Indirect Xa inhibitors, such as fondaparinux, bind to AT3, resulting in a conformational change,
thereby inhibiting factor Xa.
Drug example :
FONDAPARINUX
 Indication: prevention of venous thromboembolic events (VTE) in patients undergoing
major orthopedic surgery on lower limbs such as hip bone fracture, knee or hip
replacement surgery, patients undergoing abdominal surgery at risk of
thromboembolic complications, patients at risk of thromboembolic complications due
to acute illness, treatment acute deep vein thrombosis (DVT), treatment of acute
pulmonary embolism (PE), treatment of unstable angina or non-ST segment elevation
of myocardial infarction (UA / NSTEMI) in critical patients (<120 minutes) invasive
management [Percutaneous Coronary Intervention (PCI) ] not indicated, additional
treatment of ST segment elevation of myocardial infarction (STEMI) in patients who
are on thrombolytic treatment.
 Warning: route of administration is not allowed via intramuscular, use before and
during percutaneous coronary intervention (PCI) is not recommended, increased risk
of bleeding, increased risk of bleeding in the elderly, kidney failure (see appendix
3), pregnancy (see appendix 2), and breastfeeding (see appendix 4 )
 Contraindications: hypersensitivity, active bleeding, acute bacterial
endocarditis, severe renal impairment (creatinine clearance <20 mL /
minute).
 Side effects: general: anemia, bleeding (in various places including rare
cases such as intracranial, intracerebral, retroperitoneal bleeding), purpura,
hematoma, hematuria, hemoptysis, gum bleeding;
 Dosis: pencegahan venous thromboembolic events (VTE): 2,5 mg sehari
sekali diberikan secara sub kutan pasca bedah, dosis awal harus diberikan
minimal 6 jam setelah pembedahan selesai. Pengobatan dilanjutkan selama
5-9 hari, lansia > 75 tahun dan/ atau dengan berat badan < 50 kg
dan/atau gangguan ginjal sedang dengan kreatinin klirens 30 mL/menit
pemberian pertama tidak boleh kurang dari 6 jam setelah pembedahan
selesai, injeksi tida k boleh diberikan kecuali apabila hemostasis tercapai;
pengobatan deep vein thrombosis (DVT) dan pulmonary embolism (PE)
dosis 5 mg untuk BB < 50 kg, 7,5 mg BB 50 – 100 kg, 10 mg BB >100 kg ,
pengobatan diberikan secara sub kutan selama minimal 5 hari,
pengobatan bersama antagonis vitamin K dimulai sesegera mungkin dalam
waktu 72 jam.
 Trade name : arixtra,diviti
PARENTERAL
 Heparin
 Low molecular weight heparins

 Heparinoids

 Fondaparinux

Drug example :
HEPARIN
 Indication: treatment of deep-vein thrombosis and
pulmonary embolism, unstable angina, prophylaxis in
general surgery, myocardial infarction.
 Warning: advanced age, hypersensitivity to low
molecular weight heparin; liver and kidney disorders;
pregnancy.
 Contraindications: hemophilia and other hemorrhagic disorders,
thrombocytopenia, gastric ulcers, recent cerebral discharge. Severe
hypertension, severe liver disease (including esophageal pharynges), kidney
failure, after severe injury or surgery (including in the eye or nervous
system), hypersensitivity to heparin.
 Side effects: bleeding (see above), skin necrosis, thrombocytopenia (see
above), hypercalcemia (see above), hypersensitivity reactions (urticaria,
angiodema, and anaphylaxis); osteophoresis after long-term use (and
rarely alopecia).
 Dose: Treatment of deep-vein thrombosis and pulmonary embolism, by
intravenous injection, loading dose of 5000 units (10,000 units in severe
pulmonary embolism) followed by continuous infusion of 15-25 units / kg
bw / hour or by subcutaneous injection of 15,000 units every 12 hours
(monitoring very important laboratory every day). Young and Children
adolescents, lower charge doses, then 15-25 units / kg bw / hour by
intravenous infusion, or 250 units / kg bw / hour by subcutaneous injection.
 Trade name : inviclot,heparinol,vaxcel.
2. Antiplatelet
Antiplatelet drugs decrease platelet
aggregation and inhibit thrombus formation in the
arterial circulation, because in faster-flowing vessels,
thrombi are composed mainly of platelets with little
fibrin.
a. ASETOSAL

Indication:
prophylaxis of cerebrovascular disease or
myocardial infarction.

 Warning:
asthma; uncontrolled hypertension, peptic ulcer,
liver disorders, kidney failure, pregnancy.
 Contraindications: children under 16 years and
who are breastfeeding (Reye's syndrome) (4.7.1);
active peptic ulcer; hemophilia and other bleeding
disorders.
 Side effects: bronchospasm; gastrointestinal
bleeding (sometimes severe), and also other
bleeding (eg subconjunctiva).
 Dose: Acetosal 150-300 mg as a single dose
given immediately after the ischemic event and
then followed by long-term administration of
acetosal 75 mg once daily to prevent further heart
attack.
 Trade name : aspirin,analgan,ascardia,aptor.
b. CLOPIDOGREL
 Indication:
reduce atherosclerotic events (myocardial infarction,
stroke, and vascular death) in patients with a history of
atherosclerosis characterized by a recent stroke, new
myocardial infarction or persistent peripheral arterial
disease.
 Warning:

caution is used in patients at risk of bleeding such as


trauma, surgery or other pathological conditions;
Concomitant use with drugs that increase the risk of
bleeding. In patients who will undergo surgery and no
anti-platelet effect is needed, clopidogrel must be
stopped 7 days before. Careful use in patients with liver
failure because of the limited experience of use; kidney
function disorders, pregnancy
 Contraindications:
hypersensitivity, active bleeding such as peptic
ulcer or intracranial bleeding, breastfeeding.
 Side effects:

Dyspepsia, abdominal pain, diarrhea; bleeding


(including gastrointestinal and intracranial
bleeding); less frequent nausea, vomiting, gastritis,
flatulence
 Dose:

75 mg once a day with or without food. No dose


adjustment is needed in elderly patients or with
abnormal kidney function.
Trade name : artepid,agrelano,clidorel,copidrel.
3. Thrombolytic
Fibrinolytic works as a thrombolytic by
activating plasminogen to form plasmin, which
degrades fibrin and then breaks down thrombus.
a. ALTEPLASE

 Indication:
Thrombolytic therapy in acute myocardial infarction,
pulmonary embolism and acute ischemic stroke.
 Warning:

see the description above; for acute stroke monitor


intracranial bleeding, blood pressure (antihypertensive is
recommended if systolic above 180 mmHg or diastolic
above 105 mmHg); kidney function disorders.
 Contraindications:

in acute stroke, seizures that accompany stroke, severe


stroke, history of stroke in patients with diabetes, stroke 3
months before, hypoglycemia, hyperglycemia.
 Side effects:
the risk of brain bleeding increases in acute stroke.
Dose:

Myocardial infarction, initial therapy is given in 6-12


hours: Initial, 10 mg intravenous injection, followed
by 50 mg intravenous infusion for 60 minutes.
Acute stroke, intravenous 900 mcg / kg bw
(maximum 90 mg) for 60 minutes; 10% of the dose
is given by intravenous injection; Elderly. Not
recommended for ages above 80 years.
Trade name : cathflo,activace.
b. STREPKOKINASE
 Indication:
Deep venous thrombosis, pulmonary embolism,
acute arterial thromboembolism, thrombosis
across arteriovena; acute myocardial infarction.
 Warning: Risk of bleeding from injections or
invasive procedures, external chest compression,
pregnancy, abdominal aneurysms or conditions
where thrombolysis
 Contraindications:

Bleeding, trauma, or surgery (including tooth


extraction) that just happened, coagulation
abnormalities, bleeding diathesis, aortic dissection,
coma, history of cerebrovascular disease
 Side effects:
especially nausea, vomiting, and bleeding.
When thrombolytics are used in myocardial
infarction, reperfusion arrhythmias can occur.
 Dose:

intravenous infusion, 250,000 units for 30


minutes, then 100,000 units every hour for up to
24-72 hours according to myocardial infarction
conditions, 1,500,000 units for 60 minutes.
 Trade name : fimakinase