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-Sources of heparin:
Heparin can be obtained from pig intestinal mucosa
or from beef lung, where heparin is present
(together with histamine) in storage vesicles of
mast cells
• Coronary angioplasty or
stent placement
• Cardiac surgery
• Clotting in extracorporeal
circulations (e.g. during hemodialysis)
• Side effects of heparin:
1- Bleeding/ hemorrhage
2- Heparin-induced thrombocytopenia (HIT):
Heparin rarely but its serious complication causes
thrombocytopenia due to antiplatelet antibodies
→ Antibodies against platelet factor 4
are produced & bind to platelets
→ Platelets get activated &sticky
→ this causes:
-Thromboses
-Platelet consumption resulting in thrombocytopenia
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-Bleeding may occur as a result of thrombocytopenia
prepared by Dr.Hala zaqout
-The incidence with UFH > LMWHs
• Note:
Platelet counts should be measured necessary if UFH
used for > 5-7 days
3- Hypersensitivity: may occur rarely , commercial
preparations of heparin are obtained from animal
tissues & can cause allergy as skin rash, uriticaria,
fever
4- Osteoporosis: dose & time dependent may occur in
long-term therapy 6months
• Note:
Against fractionated heparins
(LMWHs) → Protamine is
less/not effective
47 prepared by Dr.Hala zaqout
• Heparin contraindications:
- Previous heparin-induced thrombocytopenia
syndrome (HITS(
-Dabigatran :
- Dabigatran is oral anticoagulant
- Dabigatran does not require routine monitoring
(INR) & has few drug-drug interactions compared to
warfarin
- Currently approved for prevention of stroke in
patients with AF
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-Therefore →vit K interferes with the carboxylation
of glutamic acid residues in clotting factors
II,VII, IX & X
-Warfarin inhibits the synthesis but not the actions of
these 4 clotting factors
-Warfarin as Heparin slow the production of a clot
but they do not dissolve the thrombus or clots
already present