HEMOSTATIC DRUGS

PRESENTED BY

SINDHU K

M V SC SCHOLAR,

DEPT OF VPT, COVAS, POOKODE.

Agents which attenuate BLEEDING

1.Topical hemostatics

Eg: coagulants

occlusive

vasoconstrictors

styptics

2.Systemic hemostatics

Eg: vit K

Blood & blood components

COAGULANTS

1.THROMBOPLASTIN (THROMBOKINASE ,USP )

Produced naturally by platelets & tissue in response to trauma

Commercial preparations = powder extracts from bovine brains or acetone extracted lungs or brain of rabbit

MOA = Aids hemostasis by prompt conversion of prothrombin to thrombin

Local hemostatic in surgery

2. THROMBIN ,USP

- Activated coagulation factor II a- White sterile powder prepared by

interaction of thromboplastin & calcium with prothrombin of bovine origin

- Standardized on basis of NIH units- MOA= converts endogenous fibrinogen to

fibrin for clot formation

OCCLUSIVES

Agents other than clotting factors which arrest bleeding or controls oozing from superficial capillaries by providing an artificial matrix which facilitates clotting

FIBRIN FOAM

Sponge like material prepared by action of thrombin on human fibrinogen

Fibrin foam + thrombin solution = preformed network

Traps blood oozing from surface area

Applied directly with pressure after pre soaking foam in thrombin solution

ABSORBABLE GELATIN SPONGE

-sterile water insoluble finely porous gelatin base sponge made from animal skin gelatin- Non antigenic , absorbs 30 times the its weight of whole blood-applied to surface of body or operative wounds , it liquefies 3-5 dayscompletely absorbed in 4-6 weeks

OXIDISED CELLULOSE

Surgical gauze aids coagulation by reaction between hemoglobin & cellulosic acid

Oxidation of cotton containing<16% & > 22% carboxyl group

MICROCRYSTALLINE COLLAGEN

SURFACE hemostatic agent Affinity for wet surfaces quick adherence

CALCIUM ALGINATE Addition of aqueous calcium chloride to

aqueous sodium alginate Mainly used in wound dressing

Miscellaneous

1.ZEOLITES

Microporous , aluminosilicate minerals commonly used as commercial adsorbents

2.CHITOSAN

Produced commercially by deacetylation of chitin , structural element in exoskeleton of crustaceans

In emergency conditions for quick hemostasis to stop traumatic life threatening bleeding

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VASOCONSTRICTORS

EPINEPHRINE/norepinephrine

1:100000 to 1:200000

Solution controls superficial bleeding

Opthalmic surgery,dental extractions

STYPTICS/ASTRINGENTS ACTS BY LOCAL

PRECIPITATION OF PROTEINS OF THE BLOOD & SOFT TISSUES SEALING THE BLOOD VESSELS

Ferric chloride,sulphate,subsulfate

Silver nitrate,alum,zinc chloride,chromium trioxide

SYSTEMIC HAEMOSTATICS

1.VITAMIN K & ANOLOGUES

2.BLOOD & BLOOD COMPONENTS

3.FIBRINOLYTIC INHIBITORS

4.MISCELLANEOUS - desmopressin

Vitamin K

Fat soluble vitamin & co factor for blood coagulation factors II , VII , IX , X

DEFICIENCY OF VIT K = DEFICIENCY OF II , VII , IX , X

Napthoquinolone derivative Vit k1 - phytonadione Vit k2 - menaquinone Vit k3 - menadione

Tests to detect coagulation times

Activated coagulation timeProthrombin timeActivated partial thromboplastin time

protocals

Poisoning 1st gen rodenticides- coumarin, warfarin Dogs: 0.25-2.5mg/kg BID 4-6 days Horses: 300-500mg TID 5 days Cattle: 1.1-3.3mg/kg bid 6 days

poisoning 2nd gen rodenticides- diphacinone, brodifacoum

INITIAL DOSE -5mg/kg IM or s/c to ensure therapeutic level

MAINTENANCE DOSE –2.5mg/kg daily 14 days( oral vit k supplements + fatty meal )

BLOOD & BLOOD COMPONENTS

*Fresh whole blood

*Fresh plasma

Dogs: 5-10 ml/kg IV (2-5 ml/kg/hr)

* fresh frozen plasma

Vit k dependent factors

Dogs: 10 ml/kg

*platelet rich plasma

Centrifugation @ 1200rpm 2.5 min 20’c

Dogs: 1 unit/10 kgBW slow IV

Fibrinolytic inhibitors 1.Aminocaproic acid Silmilar to aminoacid lysine Blocks activation of plasminogen to plasmin

hence inhibits fibrinolysis Dogs: 15mg/kg PO TID for adjunctive

treatment of degenerative myelopathy

2.Tranexamic acid Synthetic derivative of lysine

Miscellaneous drugs1.PROTAMINE SULFATE

Heparin over dosage – 1mg protamine for each 100 units of heparin to be inactivated slow IV

2.ADRENOCHROME MONOSEMICARBAZONE

Oxidation product of epinephrine

Systemic control of capillary bleeding , increased capillary permeability

3.ETHAMSYLATE

Works by maintaining capillary integrity

Desmopressin acetate DDAVP

Synthetic analogue of vasopressin Used in treatment of central diabetes insipidus

& to transiently elevate v WF Causes release of stored v WF from stored pool

of macrophages & endothelial cells

Dogs: 0.4 microgram/kg s/c Clinically – stopage of buccal mucosal bleeding

Commercially available gauze

Hemolytic agents

references

H S SANDHU Essentials of veterinary pharmacology & therapeutics 2nd edition.

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