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
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
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