Coagulants. According to the classification, this group of drugs is divided into direct and indirect coagulants, but sometimes they are divided according to another principle

Blood clotting is a rather complex, multi-level process that is carried out with the participation of enzymes. With a deficiency of these substances in the body, coagulation is greatly impaired. This indicator is often regarded as a symptom of the development of serious pathologies. Traditional medicine recipes are often used to increase blood coagulation. This technique is considered quite effective and in some cases gives better results than traditional medicine. Our article describes how to use folk remedies to increase blood clotting.

Who needs to increase blood clotting?

The decrease in coagulation is directly related to the amount of fibrinogen in the body. This protein is responsible for the production of fibrin clots. Its concentration may decrease due to:

• impaired liver functionality;
• immunity failures;
• thrombophilia;
• iron deficiency anemia;
• thrombocytopenia;
• vitamin deficiency;
• genetic predisposition;
• long-term therapy with anticoagulants or angiogenesis inhibitors.

When a person has low coagulability, he may suffer from severe bleeding during treatment or after tooth extraction, and it is difficult for him to treat wounds because the blood does not stop well.

Modern medicine specialists use many methods to treat this disease. As practice shows, folk remedies for blood clotting are good for bleeding: herbs improve the quality and coagulation of blood.

Contraindications

It is prohibited to use any means to improve clotting:

• after myocardial infarction;
• in the presence of pathological lesions of cerebral vessels;
• if there is a history of increased blood clotting;
• patients diagnosed with atherosclerosis;
• if various heart diseases are observed;
• when the blood condition is excessively viscous;
• with impaired heart function;
• in situations that can provoke internal hemorrhage.

Nutrition

1. As sources of protein, you need to use sea fish, eggs, and milk. You should eat chicken or turkey two to three times a week.
2. To saturate the body with omega-3, it is recommended to consume a tablespoon of flax oil daily.
3. Salad dressings are best prepared using extra virgin olive oil.
4. The diet should contain food products containing taurine: squid, shrimp, shellfish, flounder, tuna.
5. Laminaria (sea kale) helps the body better absorb iron, protein and phosphorus. Its systematic use removes “bad” cholesterol from the body and promotes better blood coagulation. Patients who cannot eat kelp are recommended to buy it in a pharmacy in dried form. The mass should be crushed and added to dishes instead of salt.
6. 30 grams of nuts will saturate the body with magnesium, calcium and potassium.
7. Whole grain bread, buckwheat, oats, barley, brown rice, millet, and daily consumption of legumes, fruits and vegetables have a positive effect on blood clotting.
8. Instead of sugar, it is better to eat honey.
9. Systematic consumption of 50 grams of sprouted wheat seed will enrich the body with vitamin E. To make it easier to eat, it needs to be dried, crushed and added to ready-made dishes.
10. Try to eat a clove of garlic or a small onion at least once every few days. These products remove LDL from the body and improve blood quality.
11. It is enough to eat one small bell pepper to improve coagulation and strengthen vascular walls. This vegetable contains large amounts of vitamin C and other beneficial substances.
12. It would not be superfluous to dilute the diet with tomatoes, squash, zucchini, pumpkin, eggplant and celery.
13. Ginger root can be added to tea or salad.
14. Melon will help make the blood more viscous.

A therapeutic diet to improve coagulation prohibits the use of:

• fatty, spicy, salty dishes;
• products containing large amounts of dyes;
• smoked meats;
• sauces, seasonings;
• "street" food;
• semi-finished products;
• fermented and pickled products;
• alcohol-containing drinks.

A decoction and extract based on pine nut shells is often used in medicine to treat numerous ailments associated with bleeding (hemorrhoids, bleeding gums, etc.).

To prepare a healing drink, you need to follow these steps.

1. 200 gr. shell (it is advisable to use the one that has retained the thin yellow shell that covers the kernel of the nut) pour 500 ml of boiling water.
2. Place over low heat (the heat intensity should keep the solution on the verge of boiling for about 20 minutes).
3. After this time, cool the broth to room temperature.
4. Strain.
5. Take a few tablespoons 2-3 times. The duration of the therapeutic course varies between 14-21 days.

Prepare the infusion according to the following scheme:

• pour the shells into a glass container, do not compact them;
• pour vodka so that it completely covers the main ingredient;
• close with a tight lid;
• leave in a secluded place for 8-11 days.

Take the finished drink one teaspoon three times a day.

Infusion of nettle leaves

Nettle is enriched with vitamins C and K, so it can be taken as an infusion and decoction. It has the following properties:

• increases blood coagulation;
• reduces sugar levels;
• increases the concentration of hemoglobin and red blood cells;
• improves metabolic processes;
• stabilizes cardiac functionality and gastrointestinal function.

To improve blood clotting, you need:

• pour a teaspoon of dried plant into 200 ml of boiling water;
• leave for 25-30 minutes;
• strain thoroughly;
• drink 100 ml 2-3 times a day for a month.

You can also use an infusion of nettle leaves:

• pour a few young leaves with 250 ml of cold water;
• bring to a boil over low heat;
• Leave the resulting broth for 40 minutes, strain through cheesecloth;
• take 150 ml daily for three weeks.

Despite its strong healing properties, nettle has certain contraindications, so it is forbidden to use it as self-medication.

This plant is also effectively used in folk medicine to improve clotting. Yarrow is characterized by:

• dilate blood vessels;
• stop bleeding;
• stop inflammatory processes;
• minimize pain;
• have antiallergic and calming effects.

Yarrow and nettle promote rapid healing of wounds, as they have a positive effect on blood viscosity. In this regard, the healing qualities of plants far outweigh the similar effect of calcium chloride. It is advisable to use yarrow to stop bleeding from the intestines, lungs, nasal cavity, etc. It is considered a rather poisonous plant, so its illiterate and prolonged use can provoke the development of:

• vitiligo;
• skin rashes;
• health problems.

To avoid such negative phenomena, it is recommended to use yarrow only as prescribed by a doctor.

Medications

Drugs that can increase blood clotting are called hemostatics or coagulants. They have a direct and indirect mechanism of action, each of them has a specific effect on the human body.

Direct-acting coagulants consist of biological components that can accelerate hemostasis. These drugs can be used orally or by injection.

Indirect coagulants are enriched with essential vitamin K, which ensures proper coagulation. Medicines in this category tend to act inside the body. A popular remedy with an indirect effect is Vikasol, a synthetic analogue of vitamin K that increases blood clotting.

Fibrinolysis inhibitors have a positive effect on hemostasis. An effective representative of this category is the drug Ambien. Medicines that stimulate platelet aggregation have a similar effect. Such drugs are Serotonin and Calcium Chloride.

Coagulants. According to the classification, this group of drugs is divided into direct and indirect coagulants, but sometimes they are divided according to another principle:

According to the classification, this group of drugs is divided into direct and indirect coagulants, but sometimes they are divided according to another principle:

1) for local use (thrombin, hemostatic sponge, fibrin film, etc.)

2) for systemic use (fibrinogen, Vicasol).

TROMBIN (Trombinum; dry powder in amp. 0.1, which corresponds to 125 units of activity; in bottles of 10 ml) is a direct-acting coagulant for topical use. Being a natural component of the blood coagulation system, it causes an effect in vitro and in vivo.

Before use, the powder is dissolved in saline solution. Typically, the powder in the ampoule is a mixture of thromboplastin, calcium and prothrombin.

Apply only locally. Prescribed to patients with bleeding from small vessels and parenchymal organs (surgeries on the liver, kidneys, lungs, brain), bleeding from the gums. Use locally in the form of a hemostatic sponge soaked in thrombin solution, a hemastatic collagen sponge, or simply by applying a tampon soaked in thrombin solution.

Sometimes, especially in pediatrics, thrombin is used orally (the contents of the ampoule are dissolved in 50 ml of sodium chloride or 50 ml of 5% Ambien solution, prescribed 1 tablespoon 2-3 times a day) for gastric bleeding or by inhalation for bleeding from the respiratory tract.

FIBRINOGEN (Fibrinogenum; in bottles of 1.0 and 2.0 dry porous mass) - used for systemic effects. It is also obtained from donor blood plasma. Under the influence of thrombin, fibrinogen is converted into fibrin, which forms blood clots.

Fibrinogen is used as an emergency medicine. It is especially effective when there is a deficiency in cases of massive bleeding (placental abruption, hypo- and afibrinogenemia, in surgical, obstetric, gynecological and oncological practice).

It is usually prescribed into a vein, sometimes locally in the form of a film applied to the bleeding surface.

Before use, the drug is dissolved in 250 or 500 ml of warmed water for injection. It is administered intravenously by drip or slow stream.

VICASOL (Vicasolum; in tablet, 0.015 and in amp. 1 ml of 1% solution) is an indirect coagulant, a synthetic water-soluble analogue of vitamin K, which activates the process of formation of fibrin blood clots. Referred to as vitamin K3. The pharmacological effect is caused not by Vikasol itself, but by the vitamins K1 and K2 formed from it, so the effect develops after 12–24 hours, with intravenous administration – after 30 minutes, with intramuscular administration – after 2–3 hours.

These vitamins are necessary for the synthesis in the liver of prothrombin (factor II), proconvertin (factor VII), as well as factors IX and X.

Indications for use: with an excessive decrease in the prothrombin index, with severe vitamin K deficiency caused by:

1) bleeding from parenchymal organs;

2) the procedure of exchange blood transfusion, if canned blood was transfused (to the child);

and also when:

3) long-term use of vitamin K antagonists - aspirin and NSAIDs (impairing platelet aggregation);

4) long-term use of broad-spectrum antibiotics (chloramphenicol, ampicillin, tetracycline, aminoglycosides, fluoroquinolones);

5) use of sulfonamides;

6) prevention of hemorrhagic disease of newborns;

7) prolonged diarrhea in children;

8) cystic fibrosis;

9) in pregnant women, especially those suffering from tuberculosis and epilepsy and receiving appropriate treatment;

10) overdose of indirect anticoagulants;

11) jaundice, hepatitis, as well as after injuries, bleeding (hemorrhoids, ulcers, radiation sickness);

12) preparation for surgery and in the postoperative period.

The effects can be weakened by simultaneous administration of vikasol antagonists: aspirin, NSAIDs, PAS, indirect anticoagulants of the neodicoumarin group. Side effects: hemolysis of red blood cells when administered intravenously.

PHYTOMENADIONE (Phytomenadinum; 1 ml for intravenous administration, as well as capsules containing 0.1 ml of a 10% oil solution, which corresponds to 0.01 of the drug). Unlike natural vitamin K1 (trans compounds) it is a synthetic preparation. It is a racemic form (a mixture of trans- and cis-isomers), and in terms of biological activity it retains all the properties of vitamin K1. It is quickly absorbed and maintains peak concentration for up to eight hours.

Indications for use: hemorrhagic syndrome with hypoprothrombinemia caused by decreased liver function (hepatitis, cirrhosis), ulcerative colitis, overdose of anticoagulants, long-term use of high doses of broad-spectrum antibiotics and sulfonamides; before major operations to reduce bleeding.

Side effects: hypercoagulation phenomena if the dosage regimen is not followed.

Among the drugs related to direct-acting coagulants, the clinic also uses the following drugs:

1) prothrombin complex (VI,VII,IX,X factors);

2) antihemophilic globulin (factor VIII).

Fibrinolysis inhibitors (antifibrinolytics)

AMINOCAPRONIC ACID (ACA) is a powdered synthetic drug that inhibits the conversion of profibrinolysin (plasminogen) into fibrinolysin (plasmin) by acting on the profibrinolysin activator and thereby contributes to the preservation of fibrin clots.

In addition, ACC is also an inhibitor of kinins and some factors of the compliment system.

It has anti-shock activity (inhibits proteolytic enzymes and also stimulates the neutralizing function of the liver).

The drug is low-toxic and is quickly eliminated from the body with urine (after 4 hours).

Used in emergency clinics, during surgical interventions and in various pathological conditions when the fibrinolytic activity of blood and tissues is increased:

1. during and after operations on the lungs, prostate, pancreas and thyroid glands;

2. with premature placental abruption, long-term retention of a dead fetus in the uterus;

3. for hepatitis, cirrhosis of the liver, for portal hypertension, when using a heart-lung machine;

4. at stages II and III of DIC syndrome, with ulcerative, nasal, and pulmonary bleeding.

ACC is administered during massive transfusions of canned blood, administered intravenously or orally.

Available: powder and bottles of 100 ml of sterile 5% solution in isotonic sodium chloride solution. Due to the fact that ACC has antishock activity, inhibits proteolytic enzymes and kinins, and inhibits the formation of antibodies, the drug is used for shock reactions and as an antiallergic agent.

Side effects: possible dizziness, nausea, diarrhea, mild catarrh of the upper respiratory tract.

AMBEN (Ambenum, aminomethylbenzoic acid) is also a synthetic drug, similar in chemical structure to para-aminobenzoic acid. White powder, poorly soluble in water. It is an antifibrinolytic agent. Ambien inhibits fibrinolysis, its mechanism of action is similar to ACC.

Indications for use are the same. Prescribed intravenously, intramuscularly and orally. When administered into a vein, it acts quickly, but only for a short time (3 hours). Release form: ampoules of 5 ml of 1% solution, tablets of 0.25.

Sometimes anti-enzyme drugs are indicated, in particular, kontrikal. It inhibits plasmin, collagenase, trypsin, chymotrypsin, which play an important role in the development of many pathophysiological processes. Drugs in this group have an inhibitory effect on the catalytic interaction of individual fibrinolysis factors and blood coagulation processes.

Indications for use: local hyperfibrinolysis – postoperative and post-portal bleeding; hypermenorrhea; generalized primary and secondary hyperfibrinolysis in obstetrics and surgery; initial stage of DIC syndrome, etc.

Side effects: rarely allergies; embryotoxic effect; With rapid administration - malaise, nausea.

This group of drugs is used to stop nasal, uterine, gastric, pulmonary and other bleeding, as well as to prevent them during operations, childbirth, hemophilia and other diseases. Drugs that increase blood clotting are either drugs - blood clotting factors or stimulants of their formation.

Reduced blood clotting can develop with liver disease, insufficient vitamin K in the body, impaired prothrombin synthesis in the liver, with a decrease in the number of platelets or hemophilia (congenital deficiency of the blood coagulation system). In such cases, heavy bleeding, increased vascular permeability and hemorrhages under the skin and into mucous tissues are observed.

Drugs that increase blood clotting are also called hemostatics, distinguishing among them natural blood clotting factors, substances that increase blood viscosity, block fibrinolysis and reduce the permeability of the vascular wall.

Preparations of natural blood clotting factors are calcium salts, vikasol, fibrinogen, thrombin, etc.

Calcium plays an important role in the blood clotting process. It is involved in the functioning of the nervous system, skeletal muscles, heart, and in the formation of bone tissue. With the participation of calcium, thromboplastin is formed, prothrombin transforms into active thrombin, vessels narrow and their walls become thicker. Calcium preparations are used to stop bleeding, for seizures, rickets, osteoporosis and allergic reactions.

CALCII CHLORIDE (Calcii chloridum) is used only in the form of a solution of 5 and 10% concentration for oral administration and 10% concentration of a sterile solution only for intravenous administration. Before injecting the drug into a vein, patients should be warned that during administration, rapid heartbeat, a feeling of heat (hot prick) and some difficulty breathing may occur. This tactic calms the patient and helps the healthcare worker avoid mistakes and getting the drug under the skin or into a muscle. If the latter happens, the patient may experience severe irritation and tissue necrosis, because a 10% calcium chloride solution is hypertonic.

REMEMBER! Hypertonic solutions of drugs are administered slowly and only into a vein. If they get under the skin or into a muscle, it causes tissue necrosis.

If a 10% solution of calcium chloride gets under the skin or into a muscle, you should immediately suck out the drug and, without removing the needle, inject a solution of magnesium sulfate, which is its antagonist, into this area.

The feeling of heat that occurs during intravenous administration of a calcium chloride solution is used in laboratory practice to determine the speed of blood flow.

Calcium hydrochloride is produced in ampoules of 5 and 10 ml of 10% solution for injection or in powder in hermetically sealed bottles for the preparation of solutions for internal use.

CALCIUM GLUCONATE (Calcii gluconas) in its pharmacological properties is close to calcium chloride, but has a weaker irritating effect, so its solutions can be injected under the skin and into the muscle.

Use calcium gluconate in tablets of 0.25-0.5 g per dose up to 3 times a day. For children, the drug is dosed depending on age and the nature of the disease. Calcium gluconate is injected into a vein in the form of a 10% solution, like calcium chloride, slowly to avoid possible complications.

Calcium gluconate is produced in tablets of 0.25 and 0.5 g and in ampoules in the form of a 10% solution of 10 ml.

VICASOL (Vicasolum) is a synthetic analogue of vitamin K, which is involved in the synthesis of prothrombin in the liver and is an antagonist of indirect anticoagulants. The therapeutic effect of Vikasol develops 8-12 hours after its administration.

Vikasol is used for nasal, pulmonary, gastric, hemorrhoidal bleeding, before childbirth, when preparing patients for surgery, hemorrhagic manifestations, etc.

Vikasol is prescribed up to 3 times a day, 1-2 tablets for 3-4 days, after which they take a break and, if necessary, repeat the course of treatment. In the form of injections, Vikasol is injected into the muscle in 1 or 2 ml of a 1% solution.

Vikasol is produced in tablets of 0.015 g and in ampoules of 1 ml of 1% solution. List B.

THROMBIN (Trombin) is a natural blood clotting factor formed from prothrombin. The drug is used only locally in the form of lotions to stop bleeding from small vessels, for burns, frostbite and during surgery on the liver or kidneys.

Thrombin solutions are prepared immediately before use under aseptic conditions in a sterile isotonic sodium chloride solution. A napkin is moistened with a thrombin solution and applied to the wound surface. The bleeding stops after 1-2 minutes, after which the napkin is carefully removed to avoid damage to the formed blood clot.

Drugs that reduce the permeability of the vascular wall and have a hemostatic effect include drugs of plant origin: yarrow herb, peppermint, shepherd's purse, logochilus intoxicating, nettle leaf, viburnum bark, etc. They are often used in the form of infusion, decoction, extract for uterine, stomach and other bleeding.

Agents affecting fibrinolysis

(fibrinolytic agents)

Human blood is constantly in a liquid state due not only to the presence of anticoagulants in it, but also to the physiological anticoagulant enzyme found in the blood - fibrinolysin (plasmin), which is capable of dissolving fibrin strands that form a blood clot.

Fibrinolytic agents are divided into two groups - direct and indirect action. The first group includes substances that directly affect blood plasma, a clot of fibrin threads and dissolve them. The second group includes stimulators of fibrinolysin synthesis. They do not act directly on fibrin threads, but when they enter the body they activate the endogenous fibrinolytic system of the blood.

The first group includes the enzyme fibrinolysin, and the second group includes fibrinolysis stimulants: streptokinase preparations, streptodecases, etc.

All of them are used for the prevention of thrombosis, treatment of thromboembolism and thrombophlebitis.

FIBRINOLYSIN (Fibrinolysinum) is an active blood protein enzyme obtained from donor blood. Its action is based on the ability to dissolve fibrin threads.

The drug is prescribed in the first hours or days after the onset of the disease, since fibrinolysin has the most active effect on fresh blood clots. Fibrinolysin does not directly affect the blood clotting process.

Indications for the use of the drug are thromboembolism of the pulmonary and peripheral arteries, cerebral vessels, fresh myocardial infarction, acute thrombophlebitis, etc.

Fibrinolysin is used in the form of a freshly prepared (in isotonic sodium chloride solution) solution for intravenous drip administration. Heparin must be added to it at the rate of 10-20 thousand units for every 20,000 units of fibrinolysin.

When using fibrinolysin, side effects are possible in the form of allergic reactions, facial flushing, fever, etc.

Fibrinolysin is produced in the form of a sterile powder in hermetically sealed bottles of 10,000, 20,000, 30,000 and 40,000 units.

The fibrinolytic agents streptolyase, streptodecase and their analogues have become more widely used. They are used to restore blood patency in thrombosed vessels, in pulmonary embolism, retinal thrombosis, and in the first day of acute myocardial infarction.

STREPTODECASE (Streptodecasum pro injectionibus) is an activator of the human fibrinolytic system, has a prolonged effect, converts blood plasminogen into active plasmin. After a single administration of a therapeutic dose, the drug provides an increase in fibrinolytic activity of the blood for 2-3 days.

Streptodecase solutions are prepared immediately before use, and treatment is carried out under the supervision of a physician in a hospital setting according to special regimens, starting with small doses.

Streptodecase should not be used after surgery, childbirth, acute pancreatitis, appendicitis, malignant tumors, peptic ulcer, liver cirrhosis, severe atherosclerosis, hemorrhagic diathesis, etc.

When using it, manifestations of allergies are possible.

Streptodecase is produced for injection in hermetically sealed 10 ml bottles containing 1,500,000 FU (fibrinolytic units).

Before use, the contents of the bottle are diluted in 10-20 ml of isotonic sodium chloride solution.

AMINOCAPRONIC ACID (Acidum aminocapronicum) is an antagonist of fibrinolytic agents, since it prevents the formation of fibrinolysin.

Aminocaproic acid is used to stop bleeding after operations on the lungs, pancreas, removal of tonsils, liver diseases, massive blood transfusions, etc.

The drug is prescribed orally in powder form 2-3 times a day, after dissolving it in sweet water or washing it down with this water. More often, to obtain a quick effect, a 5% solution of aminocaproic acid is injected into a vein, up to 100 ml, at intervals of 4 hours.

The drug should not be used if you are prone to thrombosis, embolism, or with diseases associated with impaired renal function.

Aminocaproic acid is produced in the form of powder and 5% solution for injection in 100 ml bottles, for children - in granules in a 60 g package.

Drugs affecting blood clotting

These include: 1) drugs affecting platelet aggregation; 2) drugs that increase blood clotting (coagulants); 3) drugs that reduce blood clotting (anticoagulants); 4) fibrinolysis inhibitors; 5) fibrinolysis stimulators.

The classical Schmidt-Morawitz theory (1895–1905) assumed the participation of 4 main factors in the blood clotting process: a) prothrombin - a protein synthesized in the liver with the participation of vitamin K; b) thromboplastin - an enzyme released from platelets and some tissues when cells are damaged; c) calcium ions, constantly present in the blood; d) fibrinogen - a blood protein synthesized in the liver.

It is now known that this process is much more complex and several dozen factors are involved. Some ensure adhesion and aggregation of platelets, others ensure the constant readiness of the coagulation system to enter into a coagulation reaction (procoagulants), others - inhibition of the coagulation system (anticoagulants), and fourth - the formation of a blood clot. All these factors are interconnected and in dynamic balance, due to which blood does not clot under normal conditions.

The thrombosis process goes through the following stages: 1) adhesion and aggregation of platelets; 2) activation of thromboplastin; 3) conversion of prothrombin to thrombin; 4) conversion of fibrinogen into fibrin and its polymerization. This process is complex and includes activation of the internal coagulation system (Hageman factor, plasma thromboplastin, autoprothrombin, antihemophilic globulin, etc.) and the external coagulation system (tissue thromboplastin). The fibrinolytic system involves the conversion of plasminogen to plasmin through the release of tissue activator. It inhibits excessive thrombus formation at the final stage. The anticoagulant system (braking system) slows down the blood clotting process (heparin, antithrombin-3, etc.).

They are used to stop bleeding, which is why they are called hemostatics. Coagulants include: 1) normal components of the coagulation system (vitamin K, thrombin, fibrinogen, Ca++ ions); 2) substances that increase blood viscosity (medical gelatin); 3) drugs that reduce the permeability of the vascular wall and are used for capillary bleeding (adroxon, herbal preparations, etamsylate); 4) fibrinolysis inhibitors (aminocaproic, para-aminomethylbenzoic acids, contrical).

Vitamin K preparations. Vitamin K is fat-soluble, enters the body with food and is partially synthesized by intestinal microbes. Absorption is impaired when there is insufficient flow of bile into the intestines (diseases of the liver and biliary tract), when microflora is inhibited by antibacterial drugs, and in chronic intestinal diseases. Vitamin K and its substitute vikasol ensure the synthesis of prothrombin and proconvertin in the liver. The therapeutic effect occurs after 12–18 hours. The daily requirement for vitamin K is 2 mg. The exchange occurs quickly, so if it does not enter the blood, bleeding develops after a few days. Used for vitamin K deficiency and overdose of indirect anticoagulants. Vitamin K and vikasol are contraindicated in cases of increased blood clotting.

Thrombin and hemostatic sponge (preparations from human blood) are used topically to stop bleeding from small vessels. Gauze pads and tampons are soaked in the thrombin solution and applied to the bleeding surface, and the sponge powder is applied in a thin layer.

Fibrinogen - human plasma protein, effective in cases of low levels of fibrinogen in the blood (liver disease, radiation sickness, blood loss, etc.). Available in bottles in powder form, solutions are prepared before use and administered intravenously.

Calcium preparations. Ca++ ions stimulate the formation of thromboplastin, the transition of prothrombin to thrombin and fibrin polymerization. Prescribed for hypocalcemia (eg, with citrated blood transfusion), with increased capillary permeability (radiation sickness, hemorrhagic vasculitis, bleeding from the lungs, uterus, alimentary canal), before operations. Use calcium chloride (orally and intravenously) and calcium gluconate (orally, intramuscularly and intravenously).

Gelatin medical increases blood viscosity. Prescribed orally in the form of a 5–10% solution or intravenously, 1 ml of a 10% solution per 1 kg of body weight.

Herbal products(nettle leaf, water pepper, viburnum, arnica, lagochilus intoxicating, etc.) contain tannins, vitamins K, C, P, etc. They have a stabilizing effect on the vascular wall and increase the strength of capillaries. Used in the form of infusions, decoctions, tinctures, extracts for chronic bleeding (uterine, intestinal, etc.). For this purpose they also use adroxon and etamsylate(synthetic agents) that have a stabilizing effect on capillaries, improve microcirculation and have a hemostatic effect.

Protamine sulfate - protein drug, heparin antagonist. Prescribed to neutralize heparin in case of overdose. A 1% solution is administered intravenously. PE: decreased blood pressure, bradycardia, allergies. Contraindicated in hypotension, thrombocytopenia, adrenal insufficiency.

Fibrinolysis inhibitors. When fibrinolysis is activated, fibrin threads quickly dissolve and the blood does not clot. This is due to the accumulation of plasminogen activators (fibrinolysin), which contribute to its conversion into active plasmin (fibrinolysin). Direct activators of plasminogen are tissue proteolytic enzymes (cytokinases), which are released by cell lysosomes when they are damaged, as well as trypsin. Indirect activators are enzymes of microbial origin (lysokiases), streptokinase, etc., which affect the plasminogen proactivator, converting it into an active form. Apply aminocaproic acid, ambaea(para-aminomethylbenzoic acid preparation) and kontrikal. ACC and Ambien are structurally similar to the amino acid lysine, which is part of the plasminogen activator, therefore they react with it and disrupt the interaction with plasminogen, preventing its conversion to plasmin. Contrical directly inhibits plasmin and other proteolytic enzymes (trypsin, kallikrein). Fibrinolysis inhibitors are highly active only in cases of bleeding due to fibrinolysis, which are often threatening and require emergency treatment. ACC and Ambien are prescribed orally and intravenously. They are low toxic and well tolerated.

Anti-clotting agents (antithrombotics)

These include antiplatelet agents, anticoagulants and fibrinolytics.

The process of blood clotting begins with adhesion (sticking to the vessel wall at the site of injury) and aggregation (formation of coin columns) of platelets. These processes are regulated by the thromboxane-prostacyclin system, which are formed during the conversion of arachidonic acid. Thromboxai A2 is synthesized in platelets. It inhibits adenyl cyclase and reduces cAMP content, which is accompanied by increased platelet aggregation and vasoconstriction. Collagen of the vascular wall, thrombin, ADP, serotonin, prostagland E2, and catecholamines have a similar effect. Prostacyclin is synthesized by the vascular endothelium. It activates adenylate cyclase and increases cAMP content, which leads to a decrease in platelet aggregation and vasodilation. Heparin, adenosine, AMP, methylxanthines, prostaglandin E1, serotonin antagonists, etc. have a similar effect.

Antiaggregants- substances that prevent platelet aggregation. According to MD, they are divided into the following groups: 1) agents that inhibit cyclooxygenase (acetylsalicylic acid); 2) agents that activate adenylate cyclase (prostacyclin); 3) drugs that inhibit phosphodiesterase (dipyridamole); 4) calcium antagonists (verapamil, nifedipine); 5) means of different types of action (Anturan, etc.).

Actylsalicylic acid(aspirin) inhibits cyclooxygenase, which leads to a decrease in the synthesis of endoperoxides and their metabolites - thromboxane and prostacyclin. Since the synthesis of thromboxai is inhibited to a greater extent than prostacyclin, this leads to a decrease in platelet aggregation. Platelet cyclooxygenase is irreversibly inhibited, so the antiplatelet effect lasts for several days. Cyclooxygenase of the vascular wall is restored after a few hours. The drug is prescribed to young people in small doses, to older people - in regular doses.

Prostacyclin preparations are unstable in biological media and therefore act for a short time (several minutes). This limits their use. Dipyridamole used for coronary insufficiency. The antiplatelet effect is associated with inhibition of phosphodiesterase, accumulation of cAMP and potentiation of the action of adenosine. Mechanism of antiplatelet action calcium antagonists associated with blockade of calcium entry into platelets, which leads to a decrease in their aggregation. Anturan is an anti-gout drug that has an antiplatelet effect, but the MD is not entirely clear. It is believed that it is associated with inhibition of cyclooxygenase, a decrease in ADP and serotonin.

Antiaggregates are used to prevent thrombosis. especially in diseases accompanied by a tendency to hypercoagulation (myocardial infarction, cerebrovascular accidents, thrombophlebitis, etc.), as well as in the elderly.

Anticoagulants are divided into: 1) direct-acting anticoagulants, which directly affect coagulation factors in the blood itself (heparin, sodium citrate); 2) indirect anticoagulants that affect the synthesis of blood coagulation factors in the liver (neodicumar, phenylinum, syncumar).

Heparia - a natural factor that is constantly present in the blood. It is a polysaccharide with a molecular weight of 15–20 thousand, produced by mast cells. Due to the presence of sulfuric acid residues, it has a strong negative charge, which facilitates its interaction with proteins. Heparin MD includes 5 factors: 1) reduces the formation of thromboplastin and the conversion of prothrombin to thrombin; 2) forms a heparin-antithrombin-3 complex, which inactivates prothrombin and the conversion of fibrinogen to fibrin; 3) inhibits the spontaneous polymerization of fibrin monomers; 4) weakens the accelerating effect of catecholamines and serotonin on blood clotting; 5) inhibits platelet aggregation.

Heparin is active not only in the whole body, but also when added to the blood. When taken orally, it is destroyed; with subcutaneous and intramuscular administration, the effect is inconsistent and hematomas may occur. The best effect is with intravenous administration, it occurs immediately and lasts 3–5 hours. It is destroyed in the liver by the enzyme heparinase. Metabolites are excreted by the kidneys. Before administering heparin, then every 4 hours on the first day and 2 times a day thereafter, it is necessary to determine the blood clotting time. Therapy is considered successful if the clotting time is extended by 2–3 times. Injections are given every 4–6 hours. They are used to prevent and limit thrombus formation during myocardial infarction, vascular thrombosis and embolism, during artificial circulation during operations on large vessels, when connecting an artificial kidney apparatus, and during blood transfusion. For the treatment of thrombophlebitis and trophic ulcers, it is prescribed locally and as an ointment. PE: allergies, bleeding caused by overdose. In case of overdose, protamine sulfate is administered (1 mg neutralizes 1 mg of heparin).

Sodium citrate binds Ca++ ions in the blood, as a result of which the ability of thromboplastin to cause the conversion of prothrombin to thrombin is reduced and blood clotting slows down. Used to stabilize blood during preservation, adding 10 ml of 4% solution for every 100 ml of blood. When large amounts of such blood are transfused, a Ca++ deficiency occurs in the body, which leads to a deterioration in heart function. Therefore, when transfusing more than 500 ml of “citrated” blood, 5 ml of 10% calcium chloride solution is administered intravenously for every 250 ml of blood.

Direct anticoagulants include hirudin, produced by the salivary glands of the medicinal leech. It prevents the conversion of fibrinogen to fibrin.

Anticoagulants indirect actions are divided into a) oxycoumarin derivatives (neodicoumarin, syncumar) and b) indandione derivatives (phenylin). MD is associated with a competitive interaction with vitamin K. As a result, the synthesis of prothrombin and proconvertin in the liver is disrupted. These drugs are effective only in the whole body. They have a long latent period of action (18–48 hours). They are prescribed orally, are well absorbed, act for 2–4 days and are able to accumulate. They are excreted primarily by the kidneys in the form of metabolites. Coumarin derivatives color urine pink. Some drugs are excreted unchanged in milk, which must be taken into account when breastfeeding a child. Indications: 1) thrombophlebitis, prevention of thrombosis after operations; 2) severe angina, myocardial infarction; 3) obliterating endarteritis. Contraindicated for hemorrhagic diathesis, nephritis, peptic ulcer, endocarditis, pregnancy, menstruation. Before starting treatment and during it, it is necessary to determine the blood clotting time and prothrombin index, which is understood as the ratio of normal prothrombin time to prothrombin time during treatment, expressed in %%. The index should not be less than 40%.

The most common complications of anticoagulant therapy are hemorrhages in the subcutaneous tissue, mucous membranes, and bleeding associated with overdose. In these cases, antagonists are prescribed - vitamin K and Vikasop, and blood is transfused.

Fibrinolytic agents capable of dissolving a blood clot (thrombolytic effect), which is of great practical importance. Fibrinolysin– a proteolytic enzyme that is constantly present in the blood in an inactive form (profibrinolysin, or plasminogen). Om leads the fibrin threads and prevents the formation of a blood clot. Capelio is administered intravenously in an isotonic sodium chloride solution, usually together with heparium. Streptokinase(streptolyase) - a product of hemolytic streptococcus, stimulates the conversion of plasminogen to plasmin. Capelio is administered intravenously. Streptodecase- long-acting streptokinase preparation (up to 48 hours). Urokinase - drug from urine, acts like streptokinase, but produces less PE. It is rarely used due to the difficulty of obtaining it.

Fibrinolytic drugs are effective only for fresh blood clots (no later than 3 days after their occurrence). They are used for thrombophlebitis, thromboembolism, and myocardial infarction. Monitoring the fibrinolytic activity of the blood, the content of fibrinogen and plasmiogen is mandatory. They are contraindicated in fibrinogenopenia and peptic ulcer disease. PE: fever, allergic reactions.

To avoid the occurrence of blood clots, as dangerous blood clots, in the classification of drugs there is a pharmacological group called anticoagulants - a list of drugs is presented in any medical reference book. Such medications provide control of blood viscosity, prevent a number of pathological processes, and successfully treat certain diseases of the hematopoietic system. For the recovery to be complete, the first step is to identify and remove the clotting factors.

What are anticoagulants

These are representatives of a separate pharmacological group, produced in the form of tablets and injections, which are intended to reduce blood viscosity, prevent thrombosis, prevent stroke, and in the complex therapy of myocardial infarction. Such medications not only productively reduce the coagulation of the systemic bloodstream, but also maintain the elasticity of the vascular walls. With increased platelet activity, anticoagulants block the formation of fibrin, which is relevant for the successful treatment of thrombosis.

Indications for use

Anticoagulants are used not only for the successful prevention of thromboembolism; such a prescription is suitable for increased thrombin activity and the potential threat of the formation of blood clots in the vascular walls that are dangerous to the systemic blood flow. The platelet concentration gradually decreases, the blood acquires an acceptable flow rate, and the disease recedes. The list of drugs approved for use is extensive, and they are prescribed by specialists for:

• atherosclerosis;
• liver diseases;
• vein thrombosis;
• vascular diseases;
• thrombosis of the inferior vena cava;
• thromboembolism;
• blood clots of hemorrhoidal veins;
• phlebitis;
• injuries of various etiologies;
• varicose veins

Classification

The benefits of natural anticoagulants, which are synthesized by the body and prevail in sufficient concentration to control blood viscosity, are obvious. However, natural coagulation inhibitors can be susceptible to a number of pathological processes, so there is a need to introduce synthetic anticoagulants into the complex treatment regimen. Before determining the list of medications, the patient needs to consult a doctor to rule out potential health complications.

Direct anticoagulants

The list of such drugs is designed to suppress thrombin activity, reduce fibrin synthesis, and normal liver function. These are local heparins for subcutaneous or intravenous administration, necessary for the treatment of varicose veins of the lower extremities. The active components are productively absorbed into the systemic bloodstream, act throughout the day, and are more effective when administered subcutaneously than when administered orally. Among low-molecular-weight heparins, doctors identify the following list of drugs intended for administering heparins topically, intravenously or orally:

• Fraxiparine;
• Lyoton-gel;
• Clexane;
• Fragmin;
• Hepatrombin;
• Sodium hydrogen citrate (heparin is administered intravenously);
• Klivarin.

Indirect anticoagulants

These are long-acting drugs that act directly on blood clotting. Indirect anticoagulants promote the formation of prothrombin in the liver and contain vitamins valuable for the body in their chemical composition. For example, Warfarin is prescribed for atrial fibrillation and artificial heart valves, while the recommended doses of Aspirin are less effective in practice. The list of drugs is represented by the following classification of the coumarin series:

• monocoumarins: Warfarin, Sinkumar, Mrakumar;
• indandiones: Phenilin, Omefin, Dipaxin;
• Dicoumarins: Dicoumarin, Tromexane.

To quickly normalize blood clotting and prevent vascular thrombosis after a myocardial infarction or stroke, doctors strongly recommend oral anticoagulants containing vitamin K in their chemical composition. These types of medications are also prescribed for other pathologies of the cardiovascular system that are prone to chronicity and relapses. In the absence of extensive kidney disease, the following list of oral anticoagulants should be highlighted:

• Sinkumar;
• Warfarex;
• Acenocoumarol;
• Neodicoumarin;
• Fenilin.

NOAC anticoagulants

This is a new generation of oral and parenteral anticoagulants, which are being developed by modern scientists. Among the advantages of this prescription are a quick effect, complete safety with respect to the risk of bleeding, and reversible inhibition of thrombin. However, there are also disadvantages of such oral anticoagulants, and here is a list of them: bleeding into the gastrointestinal tract, the presence of side effects and contraindications. In addition, to ensure a long-term therapeutic effect, thrombin inhibitors must be taken for a long time, without violating the recommended daily doses.

The drugs are universal, but the effect in the affected body is more selective, is temporary, and requires long-term use. In order to normalize blood clotting without serious complications, it is recommended to take one of the stated list of new generation oral anticoagulants:

• Apixaban;
• Rivaroxaban;
• Dabigatran.