The central role of thrombin in the process of clot formation makes it an important therapeutic target. Heparin is a potent anticoagulant, but has a number of limitations, in that—for example—it does not bind clot-bound thrombin, activates platelets, and may determine heparin-induced thrombocytopenia (HIT). Bivalirudin and argatroban, which belong to the class of intravenous direct thrombin inhibitors, overcome many of the limitations of heparin. Bivalirudin is currently indicated for patients undergoing percutaneous coronary intervention, patients with non-ST-segment elevation acute coronary syndromes planned for urgent or early intervention, and patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Both argatroban and bivalirudin can be used as an alternative to heparin in patients with HIT and HIT-thrombosis syndrome. This chapter describes the current clinical applications of bivalirudin and argatroban.
Direct thrombin inhibitors in acute coronary syndromes: effect in patients undergoing early percutaneous coronary intervention
