Drugs affecting the hematopoietic system can be categorized three classes: oral anticoagulants such as warfarin, antiplatelets such aspirin, and hematopoietic growth factors such as filgrastim. Oral anticoagulants inhibit the synthesis of vitamin K-dependent clotting factors X, IX, VII, and II. Antiplatelets inhibits cyclooxygenase, interferes with platelet aggregation; reduces platelet aggregation by inhibiting adenosine diphosphate pathway; protease-activated receptor-I antagonist, inhibits thrombin. Hematopoietic growth factors stimulate erythropoiesis and is used for the treatment of anemia; stimulate granulocyte formation and is used for neutropenia secondary to bone cancer and chemotherapy (Woo &Robinson, 2020).
Warfarin is one of the most widely used oral anticoagulant medications which is reduces the formation of blood clots. Warfarin is used to treat deep vein thrombosis and pulmonary embolism or prevent blood clots in veins or arteries which can reduce the risk of stroke, heart attack in the patients who have high risk of having them in the future. Warfarin dosing regimen will be calculated or individualized for the patient by the clinician using warfarin dosing calculator (warfarindosing, n.d.). Warfarin should be taken at the same time every day, never take a double dose. INR/PT test should be monitored, the patients who take warfarin must remain under the doctor care while taking it (Drug.com, 2022).
Aspirin is in a group of medications called salicylates; it is one of the antiplatelets. Aspirin works by stopping the production of certain natural substances that cause fever, pain swelling and blood clots. Aspirin is widely used as antiplatelet medication in secondary prevention to prevent heart attacks or stroke and can be consumed 81 mg, 1 p.o. daily. Statistical analysis of aspirin in patients after myocardial infarction was done by Stolarek et al. (2022)., they state that routine test should be done as well as anti-plate treatment effects. If missed the dose and it is almost time for the next dose, skip the missed dosed and continue the regular schedule. Do not take double dose to make up missed dose. A salicylates level test is most often used to evaluate aspirin poisoning, CBC should be monitoring too (Woo & Robinson, 2020).
Filgrastim usually given SQ, the brand name is neupogen. It is man-made form of granulocyte colony-stimulating factor(G-CSF). G-CSF is a substance produced by the body. It stimulates the growth of neuropils which is one of white blood cells fighting against infection. Filgrastim used myelosuppressive chemotherapy give through subcutaneous (300mcg/ml ) 5mcg/kg/d no earlier than 24 hours before next dose of chemotherapy, dose given daily for up to 2 weeks, discontinue if ANC >10000 mm3 after expected nadir or chemotherapy. CBC counts must monitored closely (Woo & Robinson, 2020).