The antithrombotic effect of dextran is mediated through its binding of erythrocytes, platelets, and vascular endothelium, increasing their electronegativity and thus reducing erythrocyte aggregation and platelet adhesiveness. Dextrans also reduce factor VIII-Ag Von Willebrand factor, thereby decreasing platelet function. Clots formed after administration of dextrans are more easily lysed due to an altered thrombus structure (more evenly distributed platelets with coarser fibrin). By inhibiting α-2 antiplasmin, dextran serves as a plasminogen activator, so possesses thrombolytic features. Outside of these features, larger dextrans, which do not pass out of the vessels, are potent osmotic agents, thus have been used urgently to treat hypovolemia. The hemodilution caused by volume expansion with dextran use improves blood flow, thus further improving patency of microanastomoses and reducing thrombosis. Still, no difference has been detected in antithrombotic effectiveness in comparison of intra-arterial and intravenous administration of dextran. Dextrans are available in multiple molecular weights ranging from 3 kDa to 2 MDa. The larger dextrans (>60,000 Da) are excreted poorly from the kidney, so remain in the blood for as long as weeks until they are metabolized. Consequently, they have prolonged antithrombotic and colloidal effects. In this family, dextran-40 (MW: 40,000 Da), has been the most popular member for anticoagulation therapy. Close to 70% of dextran-40 is excreted in urine within the first 24 hours after intravenous infusion, while the remaining 30% are retained for several more days. Other medical uses
Dextran is used in some eye drops as a lubricant.
An ACE inhibitor and thiazide combination is a drug combination used to treat hypertension (high blood pressure). They are given by mouth. ACE inhibitors reduce the activity of angiotensin-converting enzyme (ACE) which produces angiotensin II, a hormone that constricts blood vessels. Thiazides are a class of diuretics that inhibit the thiazide receptor, thereby increasing urine production and reducing excess water and salt in the body. Several organizations recommend combination therapy for hypertension in cases of failure of a single drug to achieve target blood pressure, or even as a first line treatment for some patients. Examples
Enalapril/hydrochlorothiazide (trade name Enalapril comp), wherein enalapril is the ACE inhibitor and hydrochlorothiazide is the thiazide. Quinapril/hydrochlorothiazide (trade name Accuretic)
Lisinopril/hydrochlorothiazide is marketed as Prinzide, Zestoretic, and many others. Fosinopril/hydrochlorothiazide
Fosinopril/hydrochlorothiazide (trade name Monopril HCT) has a boxed warning about its risk to cause morbidity and mortality in the baby when being used during pregnancy (2nd and 3rd trimesters).FDA  modified its labeling on February, 2009 to include a precaution of drug interaction with gold. "Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy including Monopril/Monopril HCT." See also
Perindopril/indapamide, a combination of an ACE inhibitor and a thiazide-like diuretic


== References ==