抗凝治疗和临床麻醉.pptVIP

* T-PA是人组织型纤溶酶原激活剂 * increases adhesion * * Platelets have several types of membrane-bound granules (GR) which contain a number of constituents including fibrinogen and several growth factors (e.g., PDGF). The large cell seen is a monocyte. * * * * * * * * * * * * * * * 人们早就认识到内源性和外源性凝血系统并非是独立的两个系统。如：十二因子缺乏、前激肽释放酶和高分子量激肽原缺乏并不会引起出血，而八因子和九因子缺乏所引起的出血并不能为外源性凝血系统所代偿。同样，七因子缺乏所引起的出血也不能为内源性凝血系统所代偿。研究还进一步证实TF/VIIa复合物同时能够激活IX因子和X因子。这些现象都提示两个凝血系统是相互有关联的。 * 血管壁受损，血管内皮细胞下组织（TF因子）暴露 TF因子和Ⅶa或Ⅶ 结合，后者转化为Ⅶa TF-Ⅶa复合物激活 Ⅸ、Ⅹ因子 Ⅹa与Ⅴa在细胞表面结合 Ⅹa -Ⅴa复合物将少量凝血酶原转化为凝血酶 小量凝血酶再进一步激活FⅤ、Ⅷ、Ⅺ并局部激活血小板，Ⅺa又将Ⅸ因子激活为Ⅸa * 激活的血小板结合FⅤa、Ⅷa、Ⅸa FⅧa/ Ⅸa复合物在激活的血小板表面激活FⅩ FⅩa / Ⅴa将大量的凝血酶原转化为凝血酶 产生“凝血暴发”；后者导致稳定纤维蛋白块的形成 * 人们早就认识到内源性和外源性凝血系统并非是独立的两个系统。如：十二因子缺乏、前激肽释放酶和高分子量激肽原缺乏并不会引起出血，而八因子和九因子缺乏所引起的出血并不能为外源性凝血系统所代偿。同样，七因子缺乏所引起的出血也不能为内源性凝血系统所代偿。研究还进一步证实TF/VIIa复合物同时能够激活IX因子和X因子。这些现象都提示两个凝血系统是相互有关联的。 * Normally secreted from Mast and other cells Injectable is heparin agonist Both result in prevention of conversion of fibrinogen to fibrin Description: Protamine sulfate, a protein derived from fish sperm, is a chemical antagonist of heparin. Clinically, protamine is indicated for heparin overdose and is commonly used to neutralize heparin during extracorporeal circulation following dialysis, and arterial or cardiac surgery. Protamine was approved by the FDA in December 1948. Mechanism of Action: Protamine possesses weak anticoagulant effects when administered alone; however, upon contact with heparin, it forms a salt, neutralizing the anticoagulant effect of both drugs. Protamine, a strongly basic compound, forms complexes with heparin sodium or heparin calcium, which are acidic compounds. Formation of this complex can result in disruption of the heparin-antithrombin III complex responsible for the anticoagulant activity of heparin. The protamine-heparin complex does not possess anticoagulant properties. Protamines anticoagulant effect usually is clinically insignificant and is likely the result of thromboplastin inhi