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