Professional Documents
Culture Documents
ANTICOAGULANTES,
ANTIPLAQUETRIOS E
FIBRINOLTICOS
Profa. Christianne Brtas Vieira Scaramello
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
ANTICOAGULANTES,
ANTIPLAQUETRIOS & FIBRINOLTICOS
Frmacos que impedem a formao de
trombos
Anticoagulantes: retardam ou impedem a coagulao
sangunea
Antiplaquetrios: inibem a agregao plaquetria
Fibrinolticos: dissolvem trombos patolgicos e depsitos de
fibrina
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Preveno da perda
de sangue
Hemostase
Leso vascular
Vasoconstrio
Coagulao
sangunea
Agregao
plaquetria
Tampo hemosttico
TOMBOGNESE HEMOSTASE
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Hemorragia
Agregao Coagulao
plaquetaria
Fibrinlise
Trombognese
Formao indesejada de um tampo hemosttico
(condio patolgica resultante de hipercoagulao)
Veia
Trombose
Artria
Trombose
Tecidos drenados
Veia profunda
embolia pulmonar
Edema e inflamao
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Necrose Isqumia
Coagulao sangunea
Via Intr
Intrnseca
Superf
Superfcie
externa
Via Extr
Extrnseca
Pr
Prcalicre
calicrena
Tempo de protrobina
Tempo de tromboplastina
parcial ativada
calicre
calicrena
XII
Trauma tecidual
XIIa
XI
XIa
IX
IXa *
Fator tecidual
Ca++
VII
VIIa *
X
VI
II
Ca++
VIIIa
Fosfolip
Fosfolipdos
plaquet
plaquetrios
Ca++
Xa
Xa
Xa
ZIMOGNIOS
Fosfolipidos plaquet
plaquetrios
Va
Ca++
Protrombina
Ca++
Trombina
Rede de fibrina
Ativa
Ativao
plaquet
plaquetria
Fibrinognio
Trombina
Monmeros de
fibrinognio
Ca++
Fibras de fibrina
Trombina
tPA
Plasmina
(-)
2 antiplasmina
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Adeso
&
agregao plaquetrias
Plaquetas
ADP
TxA2
vWF
fibras de colgeno
vWF: Fator von Willebrand
GpIb
Complexo 2b 3
(antigo GpIIb-IIIa)
Plaqueta
fibrinognio
Endotlio
Subendotlio
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Fator de von
Willebram
Favorecem a trombose
Seqncia de
coagulao extrnseca
Adeso
plaquetria:
Plaquetas unidas
por fibrinognio
vWF
Exposio do fator
tecidual ligado
membrana
Colagno
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Inibem a trombose
Inativa a trombina, fatores Xa, IXa
Protelise de Va, VIIIa
Ptn C ativa
Ptn C
agregao
plaquetria
Antitrombina III
(-)
trombina
Molcula semelhante
heparina
Trombomodulina
PGI2, NO
Endotlio
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
ANTIPLAQUETRIOS
Inibidor de PDE
?
ao dos fatores de coagulao
Heparina
Dipiridamol
Inibidor COX
Heparinas
de
baixo
peso Aspirina
Antagonista do
receptor para ADP
molecular
Enoxaparina
Ticlopidina
Dazoxiben
Dalteparina
Clopidogrel
Ridogrel
Certoparina
Anlogos PGI2
Antagonista TXA2
Antagonistas da trombina
Epoprostenol
Ridogrel
GR32191
FIBRINOLTICOS
Anticoagulantes orais
Catalisam converso de
Varfarina
2b 3 (GpIIb / IIIa)
plasminognio em plasmina
Dicumarol
Abciximab
Femprocumom
Tirofiban
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Estreptoquinase
Uroquinase
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
ANTICOAGULANTES PARENTERAIS
HEPARINAS
(McLean, 1916)
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
MECANISMO DE AO
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Usos clnicos
Efeitos indesejados
Profilaxia e tratamento
Hemorragia
do tromboembolismo
Trombocitopenia
venoso
Leses cutneas
Osteoporose
Infarto agudo do
Hipoaldosteronismo
miocrdio
Hipercalemia
Hemodilise
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Farmacocintica
35000 UI / 8 12 h
[H]
No atravessa a placenta
Monitorizao laboratorial
TTPa = Tempo de Tromboplastina parcial ativada
2 4
10
Administrao subcutnea
t1/2 = 40 90 min
5000 UI
Normal 26 33 segundos
[H]
ANTICOAGULANTES
ORAIS
EUA, 1920
Derivados de 4-OH
cumarinas: Varfarin (Marevan)
Dicumarol
Derivados de indan-1,3diona:
Anisindiona
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
MECANISMO DE AO
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Tempo (h)
Fatores de coagulao
Fator VII
Fator IX
24
Fator X
36
Protrombina
50
Protenas anticoagulantes
Protena C
Protena S
30
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Usos clnicos
Efeitos indesejados
valvares
Infarto
Prpura
agudo
do Dermatite urticariforme
Distrbios GI
Alopecia
Teratogenicidade
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Farmacocintica
Biodisponibilidade VO 80 100 % (ou IV)
99 % ligao a albumina plasmtica (interao AAS)
Metabolismo heptico
Fase I CYP2C9
variantes allicos 10 a 20 % caucasianos menor dose
Interaes: ? [varfarina] - Cimetidina, cloranfenicol
?J[varfarina] - Barbitricos, carbamazepina
Fase II - glicuronidao
Excreo renal (t = 25 60 h)
Create PDF with GO2PDF for free, if you wish to1/2
remove this line, click here to buy Virtual PDF Printer
Monitorizao laboratorial
TP = Tempo de Protrombina
Avaliao da via extrnseca
Sangue calcificado + tromboplastina
coagulao
Normal 12 14 segundos
Varfarin ndice normalizado Internacional (INR)
INR = TP paciente
TP controle = 2 a 4
Superdosagem: administrao de vitamina K, plasma fresco
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
ANTIPLAQUETRIOS
Efeitos indesejados:
AAS (160 320 mg / dia VO)
Irritao GI dose-dependente
Indicaes: Acidente vascular cerebral
Hipersensibilidade
Aps cirurgia de derivao coronariana
Nova estenose aps angioplastia ou tromblise Sindrome de Reye em crianas
Infarto do miocrdio
Crise isqumica transitria
t1/2 = 2 3 h; ligao a protenas plasmticas = 50 70 %
TIENOPIRIDINAS
Ticlopidina (Ticlid) dose de ataque 500 mg; dose usual 250 mg / 2x dia; t1/2 = 30 h
Clopidrogrel (Plavix) dose de ataque 300 mg; dose usual 75 mg / dia
Provavelmente pr-frmacos
Indicaes: Acidente vascular cerebral; Angioplastia (+ AAS)
Efeitos indesejados: Neutropenia reversvel, trombocitopenia, nuseas, vmitos, diarria,
rashes cutneos
Inibidores do receptor IIb/ IIIa
Tirofibam (Aggrastat) t1/2 = 30 min - Abciximab (Reopro) - Eptifibatide (Integrelin)
Indicaes: Angioplastia, angina
Preveno de restenose
Infarto do miocrdio (+AAS e heparina)
Efeitos indesejados: Hemorragia, trombocitopenia
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
AAS
AAS + clopidogrel
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
FIBRINOLTICOS
Ativao do
plasminognio
Anistreplase
Usos clnicos: IAM, trombose
venosa
profunda,
embolia
pulmonar (IV)
Estreptoquinase (Strptase)
Uroquinase (Abbokinase)
t-PA (Alteplase)
Anistreplase
Anistreplase
Estreptoquinase
Estreptoquinase
Uroquinase
Uroquinase
t-PA
0
t1/2
t-PA
Antigenicidade
10
20
90
Efeitos indesejados: Hemorragia, reaes de hipersensibilidade
Superdosagem: cido aminocaprico e cido tranexmico
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer