The means lowering or increasing blood clotting are applied in the different fields of medicine. Especially the anticoagulants and other means used for the prevention of a thrombogenesis and development of a thrombembolia which are quite often arising later surgeries, a myocardial infarction and other diseases were widely used. Recently special schemes of prolonged use of anticoagulative means (antiagregant) are developed for prevention of thromboses at the patients who had a myocardial infarction.
Anticoagulative (antitrombotichesky) means divide into 3 groups: 1) Kantikoagulyanty; 2) Kfibrinoliticheskiye means; 3) Kantiagregantnye means.
Anticoagulants generally interfere with fibrin filamentation, they interfere with a thrombogenesis, promote the termination of growth of already arisen blood clots and also impact on blood clots of endogenous fibrinolytic enzymes.
Fibrinolytic means cause destruction of the formed fibrin threads; they promote generally resorption fresh (yet not undergone the organization) blood clots.
Antiagreganta inhibit aggregation of thrombocytes and erythrocytes, reduce their ability to pasting and sticking (adhesion) to an endothelium of blood vessels. Reducing surface intention of membranes of erythrocytes, they facilitate their deformation when passing through capillaries and improve blood "fluidity". Antiagreganta are capable not only to prevent aggregation, but also to cause disaggregation of already aggregated platelets.
Anticoagulants divide into 2 groups: a) anticoagulants of direct fast (short-term) action; b) anticoagulants of indirect long action. The first are effective in vitro and in vivo. Apply them parenterally. The second act only in vivo and are effective at intake.
The main representative of anticoagulants of direct action is Kgeparin, and derivatives of 4-oxy-coumarin K belong to anticoagulants of indirect action (neodicoumarin, etc.) and Phenylindandionum (Phenilinum) [Used earlier drug from group of Phenylindandionum K Omephinum is excluded from the nomenclature of medicines as not having advantages in comparison with Phenilinum].
Fibrinolytic means divide into groups of direct and indirect action too.
Carry the substances which are directly influencing blood plasma, a clot of threads of fibrin to the first group. They are effective in vitro and in vivo. In the second group there are fibrinolysis activators. They are inactive at direct action on fibrin thread, but at introduction to an organism activate the endogenous fibrinolytic system of blood.
The representative of drugs of the first group is K fibrinolysin. As fibrinolysis activators (drugs of the second group) use drugs Kstreptokinazy (a squirrel from Ab - a hemolytic streptococcus A), including Streptasum drug (domestic drug Streptoliasum, the immobilized streptokinase drug Streptodecasum, etc.). As fibrinolytic means streptokinase drugs have the main use now. Apply proteolytic enzyme, also close on action, an urokinase.
The inhibiting influence on pasting (aggregation) of thrombocytes (and erythrocytes) is rendered to a degree by medicines of different pharmacological groups (the organic nitrates, antagonists of calcium ions derivative of purine - antihistaminic drugs, etc.). Non-steroidal anti-inflammatory drugs from which for prevention of a thrombogenesis acetylsalicylic acid has broad use have the significant anti-aggregation effect. Have the same properties Dipiridamolum, a pentoxyeagle owl (trental). New drug of this group is tiklopidin (tiklid).
Are divided also into groups and differ on the mechanism of action of means, increasing blood clotting and having gemostaticheskoye effect.
U Protamine sulfate - the specific antagonist of heparin. K Aminocapronic acid and Ambenum - fibrinolysis inhibitors. K Fibrinogen and thrombin - natural components of a coagulant system of blood. KKaltsiya dobezit t, carried to group of vasoprotectives, has pro-aggregation effect, increasing activity of thrombocytes.
A number of gemostaticheeky means of plant origin found application mainly on the basis of data of traditional medicine.