Pharmacology for Dentistry

244 Section 6/ Drug Acting on Blood

retained and is of importance for the

antithrombotic effect.

LMWH have higher bioavailability

after subcutaneous injection than

standard, heparin. LMWH binds less than

heparin to plasma proteins. The clearance

of LMWH is mainly renal, independent of

dose and slower than metabolic clearance

of heparin.

Adverse effects include thrombocytopenia,

haemorrhage, injection site ecchymoses,

osteoporosis, sensitivity phenomenon.

It is indicated in prevention and treatment

of deep vein thrombosis and pulmonary em-

bolism in surgical patients, prevention of ex-

tracorporeal thrombosis during haemodialysis.

The clinically used low molecular

weight heparins are enoxaparin, reviparin,

dalteparin, nadroparin, ardeparin and

tinzaparin etc.

HEPARINOIDS

Ancrod is an enzyme obtained from

Malayan pit viper venom. It produces

Table 6.1.3: Classification of anticoagulants.

I. Parenteral anticoagulants


 Heparin (INHEP) 5,000-10,000 U IV stat and maintained at 5,000 U

4-6 hourly


 Low molecular weight heparin (LMWH)

Nadroparin (FRAXIPARINE) 3075-4100 IU OD SC

Enoxaparin (CLEXANE) 20-40 mg OD SC

Reviparin (CLIVARINE) 13.8 mg OD SC

Dalteparin (FRAGMIN) 100-200 U/kg OD

Pamparin (FLUXUM) 6400 IU OD SC

Ardeparin (INDEPARIN) 2500-5000 IU OD SC


 Semisynthetic heparinoids

Ancrod 2 U/kg IV infusion

Heparan sulfate

Danaparoid

Lepirudin

II. Oral anticoagulants

Warfarin (WARF) 30 mg (loading) & maintained on 2.5-10 mg/day (usual

dose is 10-15 mg/day)

Bishydroxycoumarin (DICUMAROL) 200 mg × 2 days (loading), maintained on 50-100 mg/

day

Acenocoumarol (ACITROM) 8-28 mg/day (loading), maintained on 2-10 mg/day

Phenindione (DINDEVAN) 200 mg/day (loading), maintained on 50-150 mg/day

III. Fibrinolytics

Streptokinase (PROKINASE) 7,50,000-1.5 million IU in 1 hr IV infusion

Urokinase (URIDAN) 50,000-2.5 lac IV infusion

Alteplase (ACTILYSE) 10 mg IV (bolus) upto 100 mg in 3 hrs