HEMOSTATIC DRUGS IN SMALL ANIMAL PRACTICE

Quick reference to HEMOSTATIC DRUGS in veterinary practice.

1. HEMOSTATIC DRUGS PRESENTED BY SINDHU K M V SC SCHOLAR, DEPT OF VPT, COVAS, POOKODE.

2. Agents which attenuate BLEEDING 1.Topical hemostatics Eg : coagulants occlusive vasoconstrictors styptics 2.Systemic hemostatics Eg : vit K Blood & blood components

3. COAGULANTS 1.THROMBOPLASTIN (THROMBOKINASE ,USP ) Produced naturally by platelets & tissue in response to trauma Commercial preparations = powder extracts from bovine brains or acetone extracted lungs or brain of rabbit MOA = Aids hemostasis by prompt conversion of prothrombin to thrombin Local hemostatic in surgery

4. 2. THROMBIN ,USP Activated coagulation factor II a White sterile powder prepared by interaction of thromboplastin & calcium with prothrombin of bovine origin Standardized on basis of NIH units MOA= converts endogenous fibrinogen to fibrin for clot formation

5. OCCLUSIVES Agents other than clotting factors which arrest bleeding or controls oozing from superficial capillaries by providing an artificial matrix which facilitates clotting

6. FIBRIN FOAM Sponge like material prepared by action of thrombin on human fibrinogen Fibrin foam + thrombin solution = preformed network Traps blood oozing from surface area Applied directly with pressure after pre soaking foam in thrombin solution

7. ABSORBABLE GELATIN SPONGE -sterile water insoluble finely porous gelatin base sponge made from animal skin gelatin - Non antigenic , absorbs 30 times the its weight of whole blood -applied to surface of body or operative wounds , it liquefies 3-5 days completely absorbed in 4-6 weeks

8. OXIDISED CELLULOSE Surgical gauze aids coagulation by reaction between hemoglobin & cellulosic acid Oxidation of cotton containing<16% & > 22% carboxyl group

9. MICROCRYSTALLINE COLLAGEN SURFACE hemostatic agent Affinity for wet surfaces quick adherence CALCIUM ALGINATE Addition of aqueous calcium chloride to aqueous sodium alginate Mainly used in wound dressing

10. Miscellaneous 1.ZEOLITES Microporous , aluminosilicate minerals commonly used as commercial adsorbents 2.CHITOSAN Produced commercially by deacetylation of chitin , structural element in exoskeleton of crustaceans In emergency conditions for quick hemostasis to stop traumatic life threatening bleeding

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12. V ASOCONSTRICTORS EPINEPHRINE/norepinephrine 1:100000 to 1:200000 Solution controls superficial bleeding Opthalmic surgery,dental extractions

13. STYPTICS/ASTRINGENTS ACTS BY LOCAL PRECIPITATION OF PROTEINS OF THE BLOOD & SOFT TISSUES SEALING THE BLOOD VESSELS Ferric chloride,sulphate,subsulfate Silver nitrate,alum,zinc chloride,chromium trioxide

14. SYSTEMIC HAEMOSTATICS 1.VITAMIN K & ANOLOGUES 2.BLOOD & BLOOD COMPONENTS 3.FIBRINOLYTIC INHIBITORS 4.MISCELLANEOUS - desmopressin

15. Vitamin K Fat soluble vitamin & co factor for blood coagulation factors II , VII , IX , X DEFICIENCY OF VIT K = DEFICIENCY OF II , VII , IX , X Napthoquinolone derivative Vit k1 - phytonadione Vit k2 - menaquinone Vit k3 - menadione

16. Tests to detect coagulation times Activated coagulation time Prothrombin time Activated partial thromboplastin time

17. protocals Poisoning 1 st gen rodenticides- coumarin , warfarin Dogs: 0.25-2.5mg/kg BID 4-6 days Horses: 300-500mg TID 5 days Cattle: 1.1-3.3mg/kg bid 6 days poisoning 2 nd gen rodenticides- diphacinone , brodifacoum INITIAL DOSE -5mg/kg IM or s/c to ensure therapeutic level MAINTENANCE DOSE –2.5mg/kg daily 14 days( oral vit k supplements + fatty meal )

18. BLOOD & BLOOD COMPONENTS *Fresh whole blood *Fresh plasma Dogs: 5-10 ml/kg IV (2-5 ml/kg/ hr ) * fresh frozen plasma Vit k dependent factors Dogs: 10 ml/kg *platelet rich plasma Centrifugation @ 1200rpm 2.5 min 20’c Dogs: 1 unit/10 kgBW slow IV

19. Fibrinolytic inhibitors 1.Aminocaproic acid Silmilar to aminoacid lysine Blocks activation of plasminogen to plasmin hence inhibits fibrinolysis Dogs: 15mg/kg PO TID for adjunctive treatment of degenerative myelopathy 2.Tranexamic acid Synthetic derivative of lysine

20. Miscellaneous drugs 1.PROTAMINE SULFATE Heparin over dosage – 1mg protamine for each 100 units of heparin to be inactivated slow IV 2.ADRENOCHROME MONOSEMICARBAZONE Oxidation product of epinephrine Systemic control of capillary bleeding , increased capillary permeability 3.ETHAMSYLATE Works by maintaining capillary integrity

21. Desmopressin acetate DDAVP Synthetic analogue of vasopressin Used in treatment of central diabetes insipidus & to transiently elevate v WF Causes release of stored v WF from stored pool of macrophages & endothelial cells Dogs: 0.4 microgram/kg s/c Clinically – stopage of buccal mucosal bleeding

22. Commercially available gauze

23. Hemolytic agents

24. references H S SANDHU Essentials of veterinary pharmacology & therapeutics 2 nd edition. Google images