Anticoagulants and Thrombolytic Agents

Clotting of blood, which protects against hemorrhage, involves the sequential initiation, interaction, and completion of several stages in hemostasis (Table 4.2). 

Flupenthixol and procyclidine Fluphenazine Prednisone and salbutamol Betal nut (Areca catechu) Rigidity, bradykinesia, jaw tremor Betal contains arecoline, a cholinergic alkaloid Tremor, stiffness, akithesia Inadequate control of asthma Arecoline challenge causes dose-related bronchoconstriction in patients with asthma 

ACE inhibitor Theophylline Chili pepper (Capsicum spp.) Cough Capsaicin depletes substance P Increased absorption and bioavailability 

Warfarin Danshen (Salvia miltiorrhiza) Increased INR, prolonged PT/PTT Danshen decreases elimination of warfarin 

Warfarin Devil s claw (Harpagophytum procumbens) Purpura 

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Anticoagulants and thrombolytics, particularly warfarin, can systemically embolize cholesterol particles from aortic atherosclerotic plaques to small arteries and arterioles, including renal arterioles. These agents remove or prevent thrombus formation over ulcerative plaques, causing emboh. Cholesterol emboli induce an inflammatory obliterative vascular response, causing renal ischemia. Purple discoloration of the toes and mottled skin over the legs are important clinical clues. 

Hollinger, M.A. (1985). Mucokinetic agents, radionuclides, and anticoagulant-thrombolytic agents. In Respiratory Pharmacology and Toxicology. W. B. Saunders, Philadelphia, pp. 133-134. 

Arterial thrombi (white thrombi) are formed initially from both platelets and fibrin in medium-sized arteries on the basis of atherosclerosis. These thrombi can lead to symptoms of, among others, myocardial ischemia and myocardial infarction. The treatment is primarily aimed at prevention of thrombus formation with platelet aggregation inhibitors. For the treatment of myocardial infarction thrombolytic agents are used and for secondary prevention both oral anticoagulants and anti-platelet drugs are employed. 

Q9 Several pharmacological agents could theoretically be used to promote cerebral blood flow and potentially improve the outcome from a stroke. Are thrombolytic agents or anticoagulants likely to be suitable treatments for all cases of stroke ... 

The combination of thrombolytic agents with an anticoagulant and/or aspirin has been said to be life-threatening. An excess of major bleeding episodes with combined subcutaneous heparin and streptokinase or alteplase treatments (1.0% with heparin versus 0.5% without heparin) has been reported in the International Study Group Trial (103) in patients with suspected acute myocardial infarction. 

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