Medicine an Surgery notes

Apr 24th, 2015
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ANTICOAGULANTS AND THROMBOLYTIC DRUGSHaemostasisVascular injury results firstly in vasoconstriction and formation of platelet plug at the site of injury (primary haemostasis). The platelet plug is then stabilized by the formation of a fibrin meshwork, resulting from activation of the coagulation cascade.Fibrin is eventually cleared through digestion by fibrinolytic enzymes.Primary HaemostasisWhen endothelial integrity is breached, platelets adhere to exposed subendothelial collagen. The adherent platelets become activated result in;1) Exposure of fibrinogen receptors, allowing fibrinogen to bind and cross-link adjacent platelets. The process is known as platelet aggregation. The platelet fibrinogen receptor consists of a complex of glycoproteins IIb and IIIa on the platelet membrane.2) Release of contents of secretory granules including substances such as adenosine diphosphate (ADP) which promote further platelet activation.3) Synthesis of thromboxane A2 which also acts to promote further platelet activation and vasoconstriction.Activation of the coagulation cascade;The coagulation cascade can be divided into three parts;1) The common pathway consists of those reactions subsequent to the generation of factor Xa, culminating in the cleavage of fibrinogen by thrombin, with subsequent polymerization of fibrin monomers into fibrin strands. Factor Xa may be generated either by the extrinsic pathway or by the intrinsic pathway.2) In the extrinsic pathway, tissue fact

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