ANTICOAGULANTS AND THEIR EFFECT ON BLOOD-lecture

 

@KTAMF@HRI@KT] @KD TLBAZ BCCBMT FK JIFFD Ib`rkakh fjgbmtavbs   Dbcakb

`ktamf`hui`kt `kd iast tlbar usbs ak hbkbr`i

  Rkdbrst`kd tlb obml`kaso fc `mtafk fc `ktamf`hui`kts   K`ob sfob sfob fc tlb mfoofk `kta `ktamf`hui`kts mf`hui`kts ak rrfutakb futakb l`bo`tfifhy i`j   Bxpi`ak

tlb bccbmts fc `ktamf`hui`kt fk jiffd mbiis   Bxpi`ak tlb mlfamb cfr ` p`rtamui`r `ktamf`hui` `ktamf`hui`kt kt

 Aktrfdumtafk

@k `ktamf`hui`kt as ` sujst`kmb tl`t prbvbkts jiffd crfo mifttakh. @ktamf`hui`kts m`k jb usbd ak vavf (0) @s obdam`tafk bh ak tlrfojftam dasfrdbrs dasfrdbrs suml `s dbbp vbak tlrfojfsas,  puiofk`ry bojfiaso, bojfiaso, oy oyfm`rda`i fm`rda`i akc`rmtafk `k `kd d strfebs. (:) Ak obdam`i bquapobkts suml `s tbst tujbs, jiffd tr`kscusafk j`hs `kd rbk`i da`iysas bquapobkt. @ktamf`hui`kts `mlabvb tlbar bccbmt jy supprbssakh tlb syktlbsas fr cukmtafk fc v`rafus mifttakh c`mtfrs tl`t `rb kfro`iiy prbsbkt ak tlb jiffd. @ktamf`hui`kts `rb hbkbr`iiy fc twf typbs. Fkb typb lbp`rak, wlaml ` oaxturb fc oumf-pfiys`mml`radbs prfoftb `mtavaty fcas `ktatlrfojak AAA, as ` jiffd pi`so` prftbak tl`t ak`mtav`tbstl`t tlrfojak (`ktlb bkzyob tl`t prfoftbs mifttakh). Tlb ftlbr typb mfksasts fc tlb mfuo`rak dbrav`tavbs, dbrav`tavbs, wlaml aktbrcbrb ak tlb obt`jfiaso fc vat`oak E ak tlb iavbr. ]akmb vat`oak E as `k aopfrt`kt bibobkt ak tlb syktlbsas fc v`rafus mifttakh c`mtfrs, aktbrcbrbkmb ak tlb obt`jfiaso fc tl`t vat`oak havbs rasb tf mifttakh c`mtfrs tl`t `rb dbcbmtavb `kd lbkmb ak`mtavb ak tlb  jiffd. Mfuo`rak Mfuo`rak dbrav`tavb dbrav`tavbss daccbr crfo lbp`rak prao` prao`raiy raiy ak tlbar ifk ifkhbr hbr dur`tafk fc `mtafk5 fc tlbsb, tlb ofst wadbiy usbd as w`rc`rak. @ o`gfr sadb bccbmt fc

 

`ktamf`hui`kt tlbr`py as lbofrrl`hb. @ktamf`hui`kts `rb `isf usbd ak dr`wakh `kd stfrakh jiffd.

B D T@ ( btly tlyib ibkb kb da `oa kb tb tbtr`` tr``mb mbta tamm `ma `mad d) BDT@ (btlyibkbda`oakbtbtr``mbtam (btlyibkbda`oakbtbtr``mbtam `mad) as tlb ofst mfoofkiy usbd `ktamf`hui`kt ak bv`mu`tbd tujbs. At aklajats tlb mifttakh prfmbss jy rbofvakh m`imauo crfo tlb  jiffd. BDT@ as `jib tf cfro ` mfopibx watl o obt`i bt`i afks. BDT@ as syktlbsazbd fk `k akdustra`i sm`ib crfo btlyibkbda`oakb, cfro`idblydb, `kd ` sfurmb fc my`kadb (LMK fr K`MK) Tlas mlboam`i l`s jbbk usbd tf prbvbkt mifttakh ak jiffd spbmaobks sakmb tlb b`riy 012>s `kd l`s mbrt`ak `dv`kt`hbs fvbr ftlbr `ktamf`hui`kts. `ktamf`hui`kts. BDT@‑s ofst dastakmt ml`r`mtbrastam as tl`t at dfbs kft dastfrt jiffd j iffd mbiis, o`eakh at adb`i cfr lbo`tfifhy usb. Bkfuhl BDT@ oust jb prbsbkt tf prbvbkt mf`hui`tafk, jut bxmbssavb `ofukts m`usb ofrplfifham`i ml`khbs ak jiffd mbiis. Cfr akst`kmb, E :BDT@ as prbsbkt ak ` mfkmbktr`tafk fc 0.2 tf :.> oh/oi fc jiffd, at dfbs kft l`vb `ky sahkacam`kt bccbmt fk tlb jiffd mfukt p`r`obtbrs. @ii tujbs slfuid jb akvbrtbd sbvbr`i taobs () tf bksurb tlfrfuhl oaxakh `kd, tlbrbcfrb, prfpbr `ktamf`hui`taf `ktamf`hui`tafk. k.

B cc ccb bmt fc B D T@ fk Zb Z bd J if iff fd M biis ( Z J M s)7 Lahl qu`iaty jiffd sob`rs m`k jb o`db crfo tlb BDT@ tujb `s ifkh `s tlby `rb o`db watlak :-= lfurs fc tlb jiffd dr`w.   ]ob`rs

o`db crfo BDT@ tujbs tl`t sat `t rffo tbopbr`turb cfr ofrb tl`k 2 lfurs fctbk l`vb uk`mmbpt`jib `rtac`mt fc tlb jiffd mbiis (bmlakfmytam ZJMs(mrbk`tbd ZJMs(mrb k`tbd ZJMs), splbrfmytbs(` so`ii splbram`i ZJMs), `kd kbmrfjaftam ibuefmytbs(db`tl fc ibuefmytbs)) ibuefmytbs))..   Ac ` tujb as kft caiibd tf ats cuii vfiuob fc dr`w, tlb `ddatavb tf jiffd spbmaobk r`taf as `ccbmtbd, rbsuitakh ak tff lahl ` mfkmbktr`tafk fc BDT@.

 

 Ak lahl mfkmbktr`tafks, BDT@ m`usbs rbd mbiis tf slrake jbm`usb fc lypbr-tfkamaty fc tlb pi`so` watl akmrb`sbd afkam mfkmbktr`tafk `kd o`y mrb`tb `rtac`mts tl`t o`eb ZJM ofrplfifhy daccamuit tf aktbrprbt. @k bxmbss fc BDT@ `ccbmts jftl brytlrfmytbs `kd ibuefmytbs, m`usakh obojr`kb d`o`hb.

B cc ccb bmt fc B D T @ fk ^i`tb ^i`tbib ibtts7 BDT@ rbdumbs pi`tbibt `mtav`tafk jy prftbmtakh tlb pi`tbibts durakh mfkt`mt watl tlb hi`ss tujb tl`t o`y akata`tb pi`tbibt `mtav`tafk. @mtav`tafk m`usbs pi`tbibts tf miuop ak tlb prbsbkmb fc m`imauo `kd pi`tbibts `dlbrb tf tlb hi`ss surc`mb `t ` r`pad r`tb. Mlbi`tafk fc m`imauo usakh BDT@ rbsuits ak dbmrb`sbd pi`tbibt `dlbsafk fr rbtbktafk tf hi`ss.   ^sbudftlrfo ^sbudftlrfojfmytfpbka` jfmytfpbka` m`k mfopiam`tb `k

`mmur`tb dbtbroak`tafk fc `  pi`tbibt mfukt ak ` p`tabkt watl `k ukdbriyakh tlrfojfmytfpbkam tlrfojfmytfpbkam dasfrdbr. ^i`tbibt miuopakh o`y jb ` rbsuit fc pffr oaxakh - tff iattib `kd/fr tff i`tb,

`kd/fr ` so`ii, wlfib jiffd mift fr vbry so`ii cajrak mifts ak tlb BDT@`ktamf`hui`tbd spbmaobk.   @ddatafk`iiy @ddatafk`iiy,, tlb aoprfpbr mfiibmtafk fc tlb jiffd s`opib o`y m`usb tlrfojak rbib`sb `kd ` c`isbiy ifw pi`tbibt mfukt dub tf pi`tbibt `hhrbh`tafk.   Mifttakh m`k `isf jb tlb rbsuit fc aksuccamabkt BDT@, usu`iiy m`usbd jy fvbrcaiiakh tlb v`muuo tujb, fr pffr sfiujaiaty fc BDT@ (ofst mfoofkiy  K`: BDT@). At as aopfrt`kt tf jb `jib tf dastakhuasl jbtwbbk rbdumbd pi`tbibt mfukts dub tf tbmlkaqub rbi`tbd v`ra`jibs fr dub tf ` p`tabkt‑s obdam`i mfkdatafk. Tlbrb `rb twf  p`tabkt mfkdatafks ak wlaml tlb pr prbsbkmb bsbkmb fc B BDT@ DT@ m`usbs tlb pi`tbibts tf miuop. 0.  Tlb carst p`tabkt mfkdatafk, pi`tbibt s`tbiiataso, as fjsbrvbd fk ` daccbrbkta`i sob`r `s ` ’l`if‟ fr rakh fc pi`tbibts surrfukdakh wlatb jiffd mbiis (XJMs). Ac tlb spbmaobk as mfiibmtbd ak `k `ktamf`hui`kt ftlbr tl`k BDT@, tlas rakh dfbs kft fmmur. @ktajfdabs ak ofst m`sbs prfj`jiy m`usb tlas ak vatrf  plbkfobkfk. :.  Tlb sbmfkd p`tabkt mfkdatafk as psbudftlrfo psbudftlrfojfmytfpbka` jfmytfpbka` dub tf BDT@. Tlas fmmurs ak mbrt`ak p`tabkts wlf l`vb `ktajfdabs tl`t m`k jakd tf pi`tbibts. Xlbk BDT@ as `ddbd tf tlb jiffd, tlb `ktajfdabs `rb `mtav`tbd `kd m`usb  pi`tbibt miuopakh. miuopakh. Tlas plbk plbkfobkfk fobkfk as ssfobtaobs fobtaobs tbo tbopbr`turb pbr`turb dbpbkdbkt,

 

watl ofrb pi`tbibts miuopakh `s tlb jiffd mffis tf rffo tbopbr`turb `ctbr mfiibmtafk. @h`ak, ac tlb spbmaobk as mfiibmtbd ak `k `ktamf`hui`kt ftlbr tl`k BDT@, tlas dfbs kft fmmur. Fkb study slfwbd tl`t wlbk tlb jiffd s`opib w`s akmuj`tbd `t =8¾M, pi`tbibt miuopakh w`s kft sbbk, `kd `k `mmur`tb mfukt mfuid jb fjt`akbd. BDT@ prbvbkts pi`tbibts crfo miuopakh fk tlb siadb, o`eakh at b`sabr tf ofrb `mmur`tbiy bstao`tb pi`tbibt mfukts. Xlbk ` tbst rbsuit slfws ` ifw pi`tbibt mfukt, ` daccbrbkta`i sob`r slfuid jb o`db tf lbip dbtbroakb ac tlb m`usb fc tlb ifw pi`tbibt mfukt as dub tf ` p`tabkt mfkdatafk fr oaxakh fc jiffd watl BDT@.

B cc ccb bmt mtss fc fc B D T@ fk Ibuef Ibuefmy myttbs (XJ M s)7 ]tudabs l`vb dbofkstr`tbd tl`t tlb XJM mfukt rbo`akbd st`jib cfr `t ib`st = d`ys wlbk BDT@ `ktamf`hui`tbd jiffd w`s stfrbd `t rffo tbopbr`turb.  Kbutrfplais `kd ofkfmytbs ofkfmytbs `ppb`rb `ppb`rbd d tf jb tlb mbiis o ofst fst sbksatavb tf tf stfr`hb ak BDT@, wlbrb`s iyoplfmytbs wbrb tlb ofst st`jib. Xatl rbspbmt tf tlb XJM ofrplfifham ml`r`mtbrastams ml`r`mtbrastams fc BDT@-`ktamf` BDT@-`ktamf`hui`tbd hui`tbd jiffd fk stfr`hb `t `ojabkt (:>-:4¾M) tbopbr`turbs, tbopbr`turbs, ` siahlt v`mufiaz`tafk fc ofkfmytbs w`s cfukd `ctbr fkb lfur, prfhrbssakh tf ofdbr`tb `ctbr cfur lfurs5 ` siahlt v`mufiaz`tafk fc kbutrfplais w`s cfukd `ctbr =-4 lfurs, prfhrbssakh tf ofdbr`tb `ctbr 3 lfurs. Fkiy oakao`i ml`khbs ak tlb XJM ofrplfifham ml`r`mtbrastams l`vb jbbk rbpfrtbd fk stfr`hb `t 4¾M cfr `s ifkh `s 0: lfurs.

M lfaa mbs7 B D T@ Mlf Tlbrb `rb tlrbb daccbrbkt cfros fc BDT@. BDT@ as `v`ai`jib ak dasfdauo (K`:BDT@), da-pft`ssauo (E :BDT@) `kd tra-pft`ssauo (E =BDT@) s`its. E :BDT@ `kd K`:BDT@ s`its `rb mfoofkiy usbd ak dry cfro5 E =BDT@ as kfro`iiy usbd ak iaquad. E =BDT@ as daspbksbd `s ` iaquad `kd tlus m`usbs ` siahlt daiutafk fc tlb spbmaobk. Tlas s`it `isf l`s jbbk slfwk tf `ccbmt tlb rbd jiffd mbii sazb ofrb `t akmrb`sbd mfkmbktr`tafks `kd fk stfr`hb tl`k tlb E :BDT@. Tlbrbcfrb, E :BDT@ as rbmfoobkdbd `s tlb `ktamf`hui`kt fc mlfamb ak spbmaobk mfiibmtafk cfr jiffd mbii mfuktakh `kd sazakh. E :BDT@ as spr`y-drabd fk tlb w`ii fc

 

tlb tujb `kd waii kft daiutb tlb s`opib `kd as rbmfoobkdbd jy AM]L (Aktbrk`tafk`i Mfukmai cfr ]t`kd`rdaz`tafk ak L`bo`tfifhy) `kd MI]A (Miakam`i `kd I`jfr`tfry ]t`kd`rds Akstatutb) cfr l`bo`tfifhy tbstakh.

Tra-sfdauo matr`tb (K`=M3L2F8) Trasfdauo matr`tb w`s carst usbd `s `k `ktamf`hui`kt ak jiffd tr`kscusafks ak 0104,  jy @ijbrt Lustak, Lustak, ` Jbiha`k ply plysama`k sama`k `kd Iuas Iuas @hftb, `k @rhb @rhbktakb ktakb plysama`k. plysama`k. At mfktakubs tf jb usbd tfd`y ak jiffd mfiibmtafk tujbs `kd cfr tlb prbsbrv`tafk fc  jiffd ak jiffd j`kes. Tlb matr`tb afk mlbi`tbs m`imauo afks ak tlb jiffd jy cfroakh m`imauo matr`tb mfopibxbs, dasruptakh tlb jiffd mifttakh obml`kaso. ]fdauo matr`tb as bccbmtavb `s `k `ktamf`hui`kt dub tf ats oaid m`imauo-mlbi`takh  prfpbrtabs. ]fdauo matr`tb as kft usbd `s tlb rfutakb `ktamf`hui`kt cfr l`bo`tfifham`i tbsts  jbm`usb at l`s ` st`kd`rd jiffd daiutafk fc 0 p`rt fc `ktamf`hui`kt tf 1 p`rts jiffd. Tlas ob`ks l`bo`tfifhy `k`iysbr wfuid l`vb tf jb rb-m`iajr`tbd tf prbvbkt havakh brrfkbfus rbsuits. Xlbk sfdauo matr`tb as usbd cfr brytlrfmytbs sbdaobkt`tafk r`tb (B]Z) at as usbd ak ` caxbd r`taf fc 0p`rt fc tlb `ktamf`hui`kt tf 4p`rts fc jiffd. At as tlfuhlt tl`t ` lypftlbtam`i c`mtfr m`iibd sbdaobktak tl`t pi`y ` rfib ak B]Z prfmbss, as r`tlbr st`jib ak tlas `ktamf`hui`kt. Tlb crbqubktiy usbd =..0:1 oofi/I) matr`tb as sfobwl`t lypbrfsofi`r cfr rbd mbiis, rbsuitakh ak slrake`hb fc rbd mbiis `kd `rtac`mtu`i ifwbrakh ifwbrakh fc tlb l`bo`tfmrat. Tlb prbcbrrbd =.:% (>.0>1 oofi/I) matr`tb sfiutafk as asf-fsofi`r `kd lbkmb slfuid kft `ccbmt tlb l`bo`tfmrat dbtbroak`tafk. ]fdauo matr`tb as tlb `ktamf`hui`kt fc mlfamb cfr jiffd mf`hui`tafk studabs jbm`usb, tlb mifttakh c`mtfrs `ssbssbd `rb vbry st`jib ak sfdauo matr`tb jut dasaktbhr`tb r`padiy ak BDT@ BDT@ jbm`usb fc at lah lahliy liy pftbkt m`imauo mlbi`tafk bccbmt

 

Rkcfrtuk`tbiy, ftlbr `ktamf`hui`kt suml `s lbp`rak, aklajat ouitapib mifttakh c`mtfrs `kd sf m`kkft jb usbd.

Lbp`rak Lbp`rak `ktamf`hui`kt prbvbkts jiffd mifttakh jy prfoftakh tlb `mtavaty fc `ktatlrfojak AAA, ` jiffd pi`so` prftbak tl`t ak`mtav`tbs tlrfojak (`k bkzyob tl`t  prfoftbs mifttakh). mifttakh). Lbp`rak as `k `ktamf`hui`kt usbd ak miakam`i mlboastry `kd spbma`i mlboastry tbstakh. At as tlb rbmfoobkdbd `ktamf`hui`kt cfr o`ky dbtbroak`tafks usakh wlfib  jiffd fr pi`so` pi`so` spbmaobks jbm`usb jbm`usb fc ats 0.  oakao`i mlbi`takh prfpbrtabs, :.  oakao`i bccbmts fk w`tbr slacts, sl acts, =.  rbi`tavbiy ifw m`tafk mfkmbktr`tafk. Lbp`rak as tlb fkiy `ktamf`hui`kt tl`t slfuid jb usbd ak ` jiffd mfiibmtafk dbvamb cfr tlb dbtbroak`tafk fc 0.  jiffd pL, :.   jiffd h`sbs, =.  bibmtrfiytbs `kd `kd afkazbd m`imauo m`imauo,, iatlauo, zakm `kd m`rjfxyl`b m`rjfxyl`bofhifjak ofhifjak . Tlbrb `rb murrbktiy tlrbb s`its fc lbp`rak tl`t `rb mfoofkiy usbd ak jiffd mfiibmtafk dbvambs7 `oofkauo, iatlauo `kd sfdauo. Iatlauo lbp`rak as tlb rbmfoobkdbd cfro fc lbp`rak tf jb usbd jbm`usb at as ib`st iaebiy tf aktbrcbrb wlbk pbrcfroakh tbsts cfr ftlbr afks. Iatlauo lbp`rak as bssbkta`iiy crbb fc bxtr`kbfus afks. At slfuid kft jb usbd cfr mfiibmtafk fc jiffd cfr iatlauo ibvbis. Lbp`rak slfuid kft jb usbd cfr mf`hui`tafk fr l`bo`tfifhy tbstakh. Lbp`rak as kft rbmfoobkdbd jbm`usb fc crbqubktiy dbvbifpakh pi`tbibt miuops tl`t aktbrcbrb watl tlb ofrplfifham`i aktbrprbt`tafk aktbrprbt`tafk fc pi`tbibts `kd pi`tbibt mfukts. Lbp`rak as `isf kft hffd cfr jiffd caios jbm`usb at cfros ` purpib/jiub lub fk st`akbd caios.

 

@mad Matr`tb Dbxtrfsb `kd matr`tb plfspl`tb dbxtrfsb (M^D)

@mad matr`tb dbxtrfsb (@MD) as `k aopfrt`kt jiffd `ktamf`hui`kt `kd prbsbrv`tavb. Tlas `ktamf`hui`kt as o`akiy usbd cfr tlb 0.  jiffd j`ke studabs, studabs, :.  =.  4.  2. 

LI@(luo`k ibuefmytb `ktahbk) plbkftypakh, cifw mytfobtry tbstakh, tassub typakh, DK@ tbstakh. @t prbsbkt, tlbrb `rb twf wadbiy usbd cfros fc `mad matr`tb dbxtrfsb7 k`obiy sfiutafk @ `kd sfiutafk J.

]fiutafk @ mfoprasbs fc ::.> h/i Trasfdauo matr`tb, h/i matram `mad, :4.2 h/i dbxtrfsb. ]fiutafk J mfoprasbs fc 0=.: h/i trasfdauo matr`tb, 4.< h/i matram `mad, 04.8 h/i dbxtrfsb. Cfr tlb purpfsb fc `ktamf`hui`kt cfr curtlbr i`jfr`tfry studabs, batlbr sfiutafk @ fr sfiutafk J as `mmbpt`jib. Lfwbvbr, cfr tlb purpfsb fc jiffd prbsbrv`tavb, sfiutafk @ as prbcbrrbd. @MD as wfres jy wb`eiy mlbi`takh m`imauo afks tlus prbvbktakh jiffd mifttakh. Tlb dbxtrfsb `kd matram `mad o`eb @MD ` hffd rbd jiffd mbii prbsbrv`tavb. Lfwbvbr, mlbi`tafk fc m`imauo upfk stfr`hb m`usbs lypfm`im`boa` ak tlb jiffd `kd wlbk havbk cfr tr`kscusafk tr`kscusafk rbsuits ak syoptfos suml `s kuojkbss ak cakhbrs, k`usb`, btm. Jbm`usb fc tlas, @MD as kfw o`akiy rbpi`mbd jy matr`tb plfspl`tb dbxtrfsb watl `dbkakb (M^D@). Tlb stfr`hb iacb-sp`k fc ZJMs ak @MD as :0d`ys wlaibs ak M^D@, rbd mbiis mfuid jb stfrbd cfr =2d`ys. M^D@-0 mfkt`aks :3.=h trasfdauo matr`tb, =.:8h matram `mad, :.::h sfdauo dalydrfhbk plfspl`tb, =0..:82h `dbkakb pbr iatbr. 04oi as usbd cfr 0>>oi fc jiffd. M^D@-: tlb `ofukt fc dbxtrfsb as akmrb`sbd tf 44.3h `kd tl`t fc `dbkakb akmrb`sbd tf >.22h. tlb `ddatafk`i, `dbkakb l`stbk tlb ifss fc :,= D^H crfo ZJM ` sujst`kmb

 

crfo watlak ZJMs durakh hiymfsas tl`t l`s ofrb `ccakaty cfr Lj tlus at up  prfdumtafk c`maiat`takh c`maiat`takh rbib`sb fc fxyhbk crfo Lj ak tlb tassu tassubs. bs. Fx`i`tbs

Fx`i`tbs fc `oofkauo `kd pft`ssauo w`s bxtbksavbiy usbd ak l`bo`tfifhy `k `ktamf`hui`kts lfwbvbr, lfwbvbr, tlbsb `rb kf ofrb ak usb watl tlb `dvbkt fc BDT@.