PHARMA- LAB

• Hemostatis (stopping of blood flow) 


  is an essential mechanism in our body to it from both external and internal injuries.
• Without the efficient hemostasis - bleeding or internal injuries would lead to shock or death
• Hemostasis - is a complex process involving the clotting factors that are activated in a series of sequential steps, known as, "cascade"
• Diseases affecting hemostasis:

  • MI
  • CVA
  • Venous Thrombus
  • Valvular Heart Disease
• Achieved hemostasis = blood clot is formed, protecting the body from excessive hemorrhage
• Clot - may restrict blood flow to the area and must be restored for blood flow to continue.
• Fibrinolysis - is a process of clot removal initiated within 24-48 hours of clot formation until clot dissolves.
• Disorders that affect coagulation process are divided into two categories:

  • Overproduction of clots or Thromboembolic disorders
  • Clotting factor is ineffective resulting to risk for bleeding and hemorrhagic disorders
• Three major groups used to maintain or restore circulation:

  • Anticoagulants
  • Antiplatelets
  • Thrombolytics
• Anticoagulants 


  also called as "blood thinners" that prolongs bleeding time to prevent formation of blood clots
• Anti-coagulants


  acts to prevent the formation of new clots
• Anticoagulants - are used to patients at high risk for clot formation
• Conditions at high risk for clot formation:

  • Venous problems: Thrombosis and Pulmonary Embolism
  • Arterial problems: Coronary thrombosis and MI
• Side effects of Anti-coagulants (bleeding) 


  • Hemorrhage
  • Hematuria
  • Epistaxis
  • Ecchymosis - large bruise / bleeding underneath the skin
  • Gum bleeding
  • Thrombocytopenia - low platelet count
• Contraindications of Anti-coagulants (Presence of Bleeding) 


  • Active bleeding
  • Bleeding disorders
  • Blood dyscrasias
  • Disease: Ulcer, liver, kidney
• Drugs under anti-coagulants:

  • Warfarin (Coumadin)
  • Dabigatran (Praxada)
  • Rivaroxaban (Xarelto)
  • Heparin
• Warfarin (Coumadin) 


  is an oral drug that works to interfere the formation of Vitamin K clotting factors in the liver.
• Vitamin K


  used to reverse the effects of warfarin
• Prothrombin time - measure the time it takes for a blood to clot
• Warfarin (Prothrombin Time) 


  • Normal lab value: 11 - 12.5 secs
  • Therapeutic lab value: 15.5 to 35 secs
• Warfarin (International Normalized Ratio: INR) 


  • Normal lab value: 0.8 - 1.1 secs
  • Therapeutic lab value: 2-3 secs
• Longer than normal PT - may indicate: 


  • lack of clotting factors (I, II, V, VII, X)
  • lack of vit. k due to liver disease (cirrhosis) or liver injury
  • due to disseminated intravascular coagulation (DIC)
  • caused by treatment of blood thinning medications (Warfarin and Heparin)
• Dabigatran (Praxada) 


  directly inhibits thrombin, blocking the last step of clot formation
• Dabigatran is indicated to patients with non-valvular atrial fibrillation


  • approved to reduce the risk for stroke and systemic embolism
  • drug of choice than warfarin
• Rivaroxaban (Xarelto) 


  is a factor Xa inhibitor that stops the coagulation cascade in early step.
• Rivaroxaban is indicated to:


  • patients undergoing knee or hip replacement surgery
  • approved to prevent DVT, which may cause pulmonary embolism.
• Heparin


  a naturally occurring substance that inhibits the conversion of prothrombin to thrombin, blocking the conversion of fibrinogen to fibrin which is the last step of clot formation.
• Onset of action for heparin is immediate in IV and SC
• Enoxaparin 


  is a low molecular weight heparin that does not need intense monitoring.
• Protamine Sulfate 


  antidote for Heparin overdose
• Activated Partial Thromboplastin Time - is a screening test to evaluate a person's ability to form blood clot; the secs it takes to form a clot. It also assesses the amount of certain proteins in a blood.
• aPTT for Heparin


  • Normal lab value: 30-40 secs
  • Therapeutic lab value: 45-100 secs
• Warfarin therapeutic effects evaluation


  Prothrombin Time (PT) 1.5-2.5 times control value or International Normalized Ratio (INR) 2-3
• Heparin therapeutic effects evaluation


  Activated Partial Thromboplastin Time (aPTT) 1.5-3 times control value
• For anticoagulants, evaluate signs of blood loss 


  • petechiae
  • bleeding gums
  • bruises
  • dark colored: stools and urine
• for anticoagulants, during invasive procedures. Provide increase precautions against bleeding

  • use of pressure dressing
  • avoid IM injections
  • avoid rubbing the SC injection sites
• Thrombolytic medications


  selectively degrades formed fibrin clot with minimal effect on clot formation.
• Thrombolytic medications are administered to patients with disorders where intravascular clot has already formed:

  • Acute MI
  • Pulmonary Embolism
  • Acute CVA
  • DVT
• Thrombolytics for MI: Usage 


  are used within 4-6 hours of infarct inset to restore blood flow.
• Thrombolytic agents can break down clots older than 6 hours, but tissue that are already anoxic over 6 hours may not benefit from the treatment.