7. ASPIRIN ↓ Cox inhibition ↓ (PROSTACYCLIN) PGI 2 & TXA 2 (THROMBOXANE) LOW DOSE ASPIRIN

9. 1)PREVENT ARTERIAL THROMBOSIS IHD, STROKE 2) UNSTABLE ANGINA 3) RECENT MI 4) TIA 5) ARIFICIAL VALVES

10. 6) PTCA 7) PERIPHERAL ARTERIAL OCCLUSIVE DISEASE 8) CHRONIC LIMB ISCHEMIA

11. Aspirin ADR

12. DIPYRIDAMOLE - VASODILATOR - THALLIUM IMAGING - INHIBIT PLATELET ADHESION TO VESSEL WALL ↑ cAMP ↓ PLATELET CALCIUM INHIBIT AGGREGATION + ASPIRIN – STROKE, TIA ? SUPERIOR

13. CLOPIDOGREL & TICLOPIDINE INHIBIT ADP – INDUCED EXPRESSION OF PLATELET GP RECEPTORS ↓ DECREASE FIBRINOGEN BINDING ↓ DECREASE PLATELET AGGREGATION

14. CLOPIDOGREL → PRODRUG, TICLOPIDINE → NEUTROPENIA ↓ CBC – 2 WEEKS UPTO 3 MONTHS

15. THROMBOTIC STROKE SICKLE CELL ANEMIA ACS INTERMITTENT CLAUDICATION PCI CHRONIC ARTERIAL OCCLUSION OPEN HEART SURGERY AV SHUNT

16. ABCIXIMAB - PCI + Aspirin & Heparin - in MI - Bleeding, thrombocytopenia, hypotension, Brady cardia

17. TIROFIBAN & EPTIFIBATIDE - Competitive, reversible inhibitors of fibrinogen binding to GPII b / III a - ACS – unstable angina, NSTEMI - Angioplasty & stenting - Bleeding

19. FIBRINOLYTICS: Streptokinase Alteplase Urokinase Reteplase Anistreplase Tenecteplase

20. Streptokinase 1.5 million units over 60 min Alteplase 15mg bolus 0.75mg/1kg – 30 min 0.5mg/kg- 60 min

21. Reteplase – 10mg bolus 10mg after 30min Tenecteplase – IV bolus 0.5 mg /kg

22. Coagulation factor concentrates Desmopressin

23. HEMOSTATIC AGENTS: ε - Aminocaproic acid Aprotinin TOPICAL ABSORBABLE: Thrombin Microfibrillar collagen hemostat Absorbable gelatin Oxidized cellulose

24. THROMBOLYTIC THERAPY ADV- Availability, rapid administration DISADV – Intracranial hemorrhage - Uncertainty of whether normal coronary flow has been restored - Reocclusion

25. -Most effective within 12 hour (relative mortality decreased by 18%) - Little benefit beyond 12 hour Not for resolved chest pain, ST segment depression

26. Fibrin selective agents should be used with anticoagulants – UFH, LMWH, fondraparinux & bivalirudin Monitoring of thrombolytic therapy!

27. Patency is 30% PCI patency 95% (TIMI 3)

28. Persistent angina Persistent ischemic changes on ECG <50% Reduction in ST elevation 60-90 min after initiation of thrombolysis ---rescue PCI.

29. Routine coronary angiography & PCI within 24h of thrombolysis

30. Complications: Intracranial bleeding 0.7 – 0.9% Major bleeding requiring treatment 10% Venipuncture & arterial puncture.

31. Diagnosis of coagulation defects Prolonged APTTDefective Intrinsic Pathway No change in PT No change in APTTDefective Extrinsic Pathway Prolonged PT Prolonged APTTDefective in Common pathway Prolonged PT

32. Absolute C/I: 1) H/o intracranial hemorrhagic / hemorrhagic stroke 2) Ischemic stroke within 3mo 3) AVMs, aneurysms, tumor 4) Closed head injury within 3 mo 5) Aortic dissection 6) severe uncontrolled HT – SBP > 180, DBP > 110 7) Active bleeding / bleeding diathesis 8) Acute pericarditis.

33. Blood Vessel Injury IX IXa XI XIa X Xa XII XIIa Tissue Injury Tissue Factor Thromboplastin VIIa VII X Prothrombin Thrombin Fibrinogen Fribrin monomer Fibrin polymer XIII Intrinsic PathwayExtrinsic Pathway Factors affected By Heparin Vit. K dependent Factors Affected by Oral Anticoagulants

34. Thrombosis  Arterial Thrombosis : Adherence of platelets to arterial walls - White in color - Often associated with MI, stroke and ischemia  Venous Thrombosis : Develops in areas of stagnated blood flow (deep vein thrombosis), Red in color- Associated with Congestive Heart Failure, Cancer, Surgery.