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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 days
completely 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
`
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,subs
ulfate
 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 time
 Prothrombin time
 Activated 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 drugs
1.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.
 Google images

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HEMOSTATIC DRUGS IN SMALL ANIMAL PRACTICE

  • 1. HEMOSTATIC DRUGS PRESENTED BY SINDHU K M V SC SCHOLAR, DEPT OF VPT, COVAS, POOKODE.
  • 2. Agents which attenuate BLEEDING 1.Topical hemostatics Eg: coagulants occlusive vasoconstrictors styptics 2.Systemic hemostatics Eg: vit K Blood & blood components
  • 3. 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
  • 4. 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
  • 5. OCCLUSIVES Agents other than clotting factors which arrest bleeding or controls oozing from superficial capillaries by providing an artificial matrix which facilitates clotting
  • 6. 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
  • 7. 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 days completely absorbed in 4-6 weeks
  • 8. OXIDISED CELLULOSE Surgical gauze aids coagulation by reaction between hemoglobin & cellulosic acid Oxidation of cotton containing<16% & > 22% carboxyl group
  • 9. 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
  • 10. 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
  • 11. `
  • 12. VASOCONSTRICTORS EPINEPHRINE/norepinephrine 1:100000 to 1:200000 Solution controls superficial bleeding Opthalmic surgery,dental extractions
  • 13. STYPTICS/ASTRINGENTS  ACTS BY LOCAL PRECIPITATION OF PROTEINS OF THE BLOOD & SOFT TISSUES SEALING THE BLOOD VESSELS  Ferric chloride,sulphate,subs ulfate  Silver nitrate,alum,zinc chloride,chromium trioxide
  • 14. SYSTEMIC HAEMOSTATICS 1.VITAMIN K & ANOLOGUES 2.BLOOD & BLOOD COMPONENTS 3.FIBRINOLYTIC INHIBITORS 4.MISCELLANEOUS - desmopressin
  • 15. 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
  • 16. Tests to detect coagulation times  Activated coagulation time  Prothrombin time  Activated partial thromboplastin time
  • 17. 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 )
  • 18. 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
  • 19. 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
  • 20. Miscellaneous drugs 1.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
  • 21. 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
  • 24. references  H S SANDHU Essentials of veterinary pharmacology & therapeutics 2nd edition.  Google images