blood clots
DESCRIPTION
Blood clots. Objectives. Why does blood clot? How does blood clot? Controlling blood clots Pharmaceutical intervention. Why does blood clot?. Virchow’s Triad... Endothelial injury Stress, turbulent flow, scarred valves Increased collagen exposure Altered blood flow - PowerPoint PPT PresentationTRANSCRIPT
Why does blood clot?
How does blood clot?
Controlling blood clots
Pharmaceutical intervention
Virchow’s Triad... Endothelial injury
○ Stress, turbulent flow, scarred valves
○ Increased collagen exposure Altered blood flow
○ Turbulence, due to plaques, aneurysms, sickle-cell Hypercoaguability
○ Genetic or acquired○ Mutations in factors, MI, heparin, AF, COCP, sickle
cell
Vascular Spasm
Platelet Plug Formation
Coagulation Cascade
Damage to arteries = Circular muscle contraction
Caused by - platelet secretions - nociceptor inhibition
Damaged endothelium exposes ECM Platelets adhere via von Willebrand factor
Thromboxane A2 + Serotonin Vasoconstriction
Thromboxane A2 + ADP Platelet Aggregation
* Primary Haemostatic Plug
Clotting factors
ADPSerotonin
Fibrin-stabilising factor (XIII)
Thromboxane A2
X
II
I
TF + Ca2+
VII TF - VIIa
Damaged tissue...
Xa + Va
IIa
Ia
XIII
XIIIa
XII
XIXIa
XIIa
IXIXa
X
VIIIa + Thrombin (IIa) catalyses the conversion of...
V Va
VIII VIIIa
Damaged cells...
Clot retraction
Fibrinolytic system○ Dissolves clots via fibrinolysis○ Thrombin, XIIa, tissue plasminogen activator (t-Pa)
activate plasminogen plasmin○ Plasmin breaks down fibrin and inactivates Ia, IIa,
Va, XIIa WBC/endothelium secrete prostcyclin
(inhibit thromboxane A2) Antithrombin inhibits IIa, Xa, XIIa PC + Thrombomodulin inactivates Va & XIIIa
X
II
I
TF + Ca2+
VII TF - VIIa
Damaged tissue...
Xa + Va
IIa
Ia
XIII
XIIIa
XII
XIXIa
XIIa
IXIXa
X
VIIIa +
Damaged cells...
Antithrombin
Activated Protein C
Plasmin
Heparin○ Speeds up antithrombin action○ Immediate action○ 2 types: unfractioned and LMWH○ Use for DVT prophylaxis post-op
Warfarin○ Inhibits vitamin K reductase, so inactivates clotting
factors○ 3 days before action○ Use as long term anticoagulant, e.g. Prophylaxis,
AF, hip surgery, prosthetic heart valves.
Used within 12hours of MI, thromboembolic stroke, arterial clots
Streptokinase○ Catalyses conversion of plasminogen to plasmin○ Increased risk of bleeds and allergic reaction
Alteplase○ Cleaves plasminogen into plasmin○ Increased risk of stroke