242 Section 6/ Drug Acting on Bloodhaemorrhage and secondary haemorrhage
from wounds.
FERACRYLUM
It is a local haemostatic and antiseptic
agent. The haemostatic effect of feracrylum
is based on the formation of synthetic
complex consisting of its adduct with
plasma proteins principally albumin. Like
other biodegradable polymers, the
feracrylum-albumin complex formed gets
broken down over a period of time.
Adverse effects include burning
sensation.
It is indicated as adjunct to conventional
haemostatic procedures in capillary and
venule oozing in various surgical and
diagnostic procedures, dental extraction and
oral surgeries.
APROTININ
It is a naturally occurring proteolytic
enzyme inhibitor acting on plasmin and
kallikrein.
It inhibits plasmin and kallikrein, thus
directly affecting fibrinolysis. It also
inhibits the contact phase activation of
coagulation which both initiates coagulation
and promotes fibrinolysis.
After IV injection rapid distribution of
aprotinin occurs into the total extracellular
space leading to a rapid initial decrease in
plasma concentration. It has a plasma half-
life of 2.5 hours. After a single IV dose 25-
40% is excreted in the urine over 48 hours.
It is accumulated primarily in the kidney (it
is actively absorbed by the proximal
tubules).
Adverse effects include local thrombo-
phlebitis, hypersensitivity reactions (skin
eruptions, tachycardia, pallor/cyanosis,
dyspnoea, nausea or anaphylactic shock)
may occur.
It is indicated in patients at high risk of
blood loss following open heart surgery with
extracorporeal circulation, life threatening
haemorrhage due to hyperplasminaemia,
hyperfibrinolytic haemorrhage occurring
post-traumatically and postoperatively e.g.
in obstetrics and gynaecology.TRANEXAMIC ACID
Tranexamic acid produces an
antifibrinolytic effect by blocking the lysine
binding site on plasminogen which is
essential for binding to fibrin and thereby
prevents the activation of plasminogen on
the surface of fibrin.
Tranexamic acid is absorbed from the
GIT with peak plasma concentration at
about three hours. Bioavailability is about
30 to 50 percent. It is widely distributed
throughout the body and has very low
protein binding. It diffuses across the
placenta and is distributed into breast milk.
It has a plasma half life of about two hours.
It is excreted in the urine mainly as
unchanged drug.
Adverse effects include dose related
gastrointestinal disturbances, hypotension
particularly after rapid IV administration
and transient disturbance in colour vision
rarely.
It is used for prophylaxis and control of
bleeding in gynaecological and obstetric
surgery, haemorrhage associated with IUCD
insertion, conisation of the cervix, intra- and