USEFUL FOR MBBS CLASSES

1. DR.SUMITHA A MBBS.,MD
ASSISTANT PROFESSOR
PHARMACOLOGY

2. I. Used in vivo
A. Parenteral anticoagulants
(i) Indirect thrombin inhibitors: Heparin, Low
molecular weight heparins, Fondaparinux,
Danaparoid
(ii) Direct thrombin inhibitors: Lepirudin,
Bivalirudin, Argatroban
B. Oral anticoagulants
(i) Coumarin derivatives: Bishydroxycoumarin
Warfarin sod, Acenocoumarol
Ethylbiscoumacetate
ANTICOAGULANTS

3. ii) Indandione derivative: Phenindione.
(iii) Direct factor Xa inhibitors: Rivaroxaban
(iv) Oral direct thrombin inhibitor: Dabigatran
etexilate
II. Used in vitro
A. Heparin:
150 U to prevent clotting of 100 ml blood.
B. Calcium complexing agents: Sodium citrate

4. ORAL ANTICAGULANTS -WARFARIN

5. ORAL ANTICAGULANTS

6. Warfarin Dose
 Prophylaxis and treatment of venous thrombosis and its
extension, pulmonary embolism (PE)
 Initial dose: 2-5 mg PO qDay for 2 days.
 Initiate warfarin on day 1 or 2 of LMWH or
unfractionated heparin therapy and overlap until desired
INR,then discontinue heparin.
 Check INR after 2 days and adjust dose according to
results
 Maintenance dose - 2 and 10 mg/day

10. Adverse effects
 Bleeding-ecchymosis,hematuria,bleeding in git.
 Occurs if INR –Exceeds 4
 INR-International normalised ratio.
 INR-ratio of prothrombin time during treatment with
ora;l anticoagulant with normal value of prothrombin
In healthy people an INR of 1.1 or belowis normal.
2.Teratogenic effects:
Foetal warfarin syndrome- hypoplasia of nose.eye
socket,hand bones ,growth retardation.
3.Alopecia,dermatitis,diarrhoea

11. Adverse effects
 Bleeding-ecchymosis,hematuria,bleeding in git.
 Occurs if INR –Exceeds 4
 INR-International normalised ratio.
 INR-ratio of prothrombin time during treatment with
ora;l anticoagulant with normal value of prothrombin
In healthy people an INR of 1.1 or belowis normal.
2.Teratogenic effects:
Foetal warfarin syndrome- hypoplasia of nose.eye
socket,hand bones ,growth retardation.
3.Alopecia,dermatitis,diarrhoea

13. DRUG INTERACTIONS OF WARFARIN

14. Newer oral anticoagulants
Direct factor Xa inhibitors: Rivaroxaban,apixaban,Edoxaban
Apixaban-10 mg BD for 7 days followed by 5 mg BD.For TREATMENT
OF DVT and PE.
Oral direct thrombin inhibitor: Dabigatran
Etexilate.
Rapid onset and offset of therapeutic effect.
Short half life
No laboratory monitoring required
Lower risk of bleeding
Fewer drug interactions
Antithrombotic efficacy equal to warfarin.

16.  THANK YOU