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ANTI TROMBANTI TROMBTI COSTI COSANTI COAGULANTES,ANTI COAGULANTES,

ANTI PLAQUETANTI PLAQUET RI OS ERI OS E

FI BRI NOLFI BRI NOLTI COSTI COSProf a. Christianne Brtas Vieira ScaramelloProf a. Christianne Brtas Vieira Scaramello

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ANTI COAGULANTES,ANTI COAGULANTES,

ANTI PLAQUETANTI PLAQUET RI OS & FI BRI NOLRI OS & FI BRI NOLTI COSTI COSFrmacos que impedem a f ormao de

trombos

Anticoagulantes:retardam ou impedem a coagulao

sangunea

Antiplaquetrios:inibem a agregao plaquetria

Fibrinolticos:dissolvem trombos patolgicos e depsitos de

fibrina

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PrevenPreveno da perdao da perdade sanguede sangue

HemostaseHemostase

Leso vascular

Vasoconstrio Agregaoplaquetria

Coagulaosangunea

Tampo hemosttico

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Coagulao FibrinFibrinliseliseAgregaoplaquetaria

HemorragiaHemorragia

TrombogneseTrombognese

Formao indesejada de um tampo hemosttico

(condio patolgica resultante de hipercoagulao)

TromboseArtria

Necrose I squmia

Tr omboseVeia

Tecidos drenados

Edema e inf lamaoVeia profundaembolia pulmonar

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Coagulao sangunea

Via ExtrVia Extrnsecanseca

Ca++

Trauma tecidualTrauma tecidual

Fator tecidualFator tecidual

XX XaXaVIIVII VIIaVIIa** Ca

++

TrombinaTrombinaCa++

ProtrombinaProtrombina

Fosfolipidos plaquetFosfolipidos plaquetriosrios Ca++VaVa VV

Via IntrVia Intrnsecanseca

FosfolipFosfolipdosdosplaquetplaquetriosrios

Ca++

SuperfSuperfciecieexternaexterna

PrPr--calicrecalicrenana

calicrecalicrenana

XIIXII XIIaXIIa

XIXI XIaXIa

IXIX IXaIXa**

VIVI

IIII

VIIIaVIIIa

XX XaXa

XaXa

Rede de fibrinaRede de fibrina

AtivaAtivaooplaquetplaquetriaria

Tempo de tromboplastinaparcial ativada

Tempo de protrobina

ZI MOGNI OS

Fatores inativos f ormados no f gado.

A TI VA O (I I , VI I , I X , X )

carboxilao do resduo de cidoglutmico

cof ator - vit K reduzida

(restaurada pela vit K redutase)

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2 antiplasmina

(-)

TrombinaTrombinaFibrinognioFibrinognio Monmeros deMonmeros de

fibrinogniofibrinognio

Rede de fibras de fibrinaRede de fibras de fibrina

Fibras de fibrinaFibras de fibrina

TrombinaTrombina

fator estabilizador de fibrina (XIIIa)fator estabilizador de fibrina (XIIIa)

Ca++

PlasminaPlasminognio

(-)

tPA

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Endotlio

Subendotlio

Fator de vonWillebram

Complexo2b 3(antigo GpI I b- I I I a)

f ibrinognio

PlaquetaGpI b

Adeso&

agregao plaquetrias

f ibras de colgeno

TxA2ADP

Plaquetas

vWFvWF: Fator von Willebrand

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Colagno

Adesoplaquetria:Plaquetas unidaspor f ibrinognio

Seqncia decoagulao extrnseca

vWF

Exposio do fatortecidual ligado

membrana

Favorecem a tromboseFavorecem a trombose

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Inativa a trombina, fatores Xa, IXa

Protelise de Va, VIIIa

Ptn C ativa Ptn C

Antitrombina III

trombina PGI2, NO

agregaoplaquetria

Trombomodulina EndotlioMolcula semelhante heparina

I nibem a tromboseI nibem a trombose

(-)

S

+ ativador tecidual de plaminognio (tPA)

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ANT I COAGULANT ES

?ao dos fatores de coagulao

HeparinaHeparinas de baixo peso

molecular

Enoxaparina

DalteparinaCertoparina

Antagonistas da trombina

Hirudina Hirulog Lepirudina

Anticoagulantes orais

VarfarinaDicumarol

Femprocumom

Classif icaClassif icao dos Antitrombo dos Antitrombticosticos

ANTI PLAQUETRI OS

Inibio da formao de TXA2

Inibidor COX

Aspirina

Inibidor TXA2 sintase

Dazoxiben

RidogrelAntagonista TXA2

Ridogrel

GR32191

Inibidores dos receptores

2b 3 (GpIIb / IIIa)Abciximab

Tirofiban

FI BRI NOL TI COS

Catalisam converso de

plasminognio em plasminaEstreptoquinase

Uroquinase

Inibidor de PDE

DipiridamolAntagonista do

receptor para ADP

Ticlopidina

Clopidogrel

Anlogos PGI2Epoprostenol

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ANT I COAGULANT ES PARENTERAI SANT I COAGULANT ES PARENTERAI S

HEPARI NASHEPARI NAS

(McLean, 1916)

Fontes: mucosa intestinal suna, pulmo bovino

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MECANI SMO DE AO

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Usos clnicos Ef eitos indesejados

Profilaxia e tratamentodo tromboembolismo

venoso

Angina instvel (+ AAS)Infarto agudo do

miocrdio

Hemodilise

Hemorragia

Trombocitopenia

Leses cutneas

Osteoporose

Hipoaldosteronismo

Hipercalemia

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Farmacocintica

2 4 6 8 10 h

Administrao subcutnea

t1/2

= 40 90 min

35000 UI / 8 12 h

[H]

5000 UI

1200 - 1600 UI

Infuso contnua

Janela teraputica: 0,3 0,7 U / mL

[H]

Superdosagem:sulfato de protamina 1 %

No atravessa a placenta

Monitorizao laboratorial

TTPa = Tempo de Tromboplastina parcial ativada

Avaliao da via intrnseca

Sangue calcificado + fosfolipdeos

Coagulao

Normal 26 33 segundos

heparina 1,5 a 2,5 x maior

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LMWH:LMWH: Biodisponibilidade SC; efeito previsvel; auto-administrao; baixo

ndice de trombocitopenia; risco de sangramento e osteopenia

DANAPARDANAPARIDEIDE (Orgaran)::contra fator Xa, s/ antdoto, monitorar c/ anti-Xa

84% heparan

12% dermatan

4% condroitina sulfato

LEPIRUDINALEPIRUDINA (Refludan): fator IIa- s/antdoto, ac anti-hirudina, cuidado c/

insuficincia renal

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ANTI COAGULANTESANTI COAGULANTES

ORAI SORAI S

EUA, 1920

Derivados de 4-OH

cumarinas: Varfarin (Marevan)

Dicumarol

Derivados de indan-1,3-

diona:

Anisindiona

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