Anticoagulant prostanoids

The effects of the prostanoids depend on the balance between thromboxane and epoprostenol (prostacyclin). At a wounded endothelial surface the effects of thromboxane predominate, allowing platelet activation, aggregation, and plugging of the vessel wall. There is also local vasoconstriction to reduce blood flow into the wounded area. Epoprostenol is the most potent inhibitor of platelet aggregation known and is a potent vasodilator. Anticoagulation may be achieved with epoprostenol by ablating local thromboxane effects or if infused into an extracorporeal circulation where the thromboxane levels are extremely low. Effects are dose dependent and last for up to 30 min after discontinuing an infusion. At high doses epoprostenol may disperse circulating platelet aggregates.

Alprostadil (prostaglandin E.,) has similar effects to epoprostenol, but is up to five times less potent. It is also metabolized in the lungs so that systemic vasodilatation effects should be minimal. This may be an important advantage in the shocked patient.

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