September 7, 2005New England Journal of Medicine653 citationsOpen Access
Direct Thrombin Inhibitors
Key Result
Direct thrombin inhibitors are effective alternatives to heparin for specific indications such as heparin-induced thrombocytopenia and percutaneous coronary intervention, but lack clear superiority for routine use in acute coronary syndromes or venous thromboembolism prophylaxis.
Structured PICO
P
Population
A comprehensive review of patients requiring anticoagulation for the prevention and treatment of arterial and venous thrombosis, including acute coronary syndromes, atrial fibrillation, and orthopedic surgery.
I
Intervention
Parenteral direct thrombin inhibitors (hirudin, argatroban, bivalirudin, desirudin)
Direct thrombin inhibitors are a class of anticoagulants with specific FDA-approved indications including heparin-induced thrombocytopenia, percutaneous coronary intervention, and venous thromboembolism prophylaxis.
Limitations
- Lack of a specific antidote for rapidly reversing the anticoagulant effect of DTIs
- Hepatic toxicity concerns with long-term use of certain oral DTIs like ximelagatran
- The best method to monitor therapy with DTIs has not been clearly established
Abstract
Direct thrombin inhibitors (DTIs) are a new class of anticoagulants that bind directly to thrombin and block its interaction with its substrates. Four parenteral DTIs have been approved by the FDA — hirudin and argatroban for heparin-induced thrombocytopenia, bivalirudin as an alternative to heparin in percutaneous coronary intervention, and desirudin as prophylaxis against venous thromboembolism in hip replacement. This article discusses the clinical data on this important new class of medications.