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Direct thrombin inhibitor therapy in the cardiovascular patient

James H Chesebro1

  • 1Division of Cardiovascular Disease, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224-1865, USA. chesebro.james@mayo.edu

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|November 5, 2003
PubMed

Insights

Direct thrombin inhibitors (DTIs) effectively prevent thrombus formation in cardiovascular patients, particularly those with acute coronary syndromes. DTIs are vital for managing heparin-induced thrombocytopenia (HIT) and reducing coronary events.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Thrombosis Research

Background:

  • Patients with acute coronary syndromes (ACS) are at high risk of mural thrombi formation.
  • Heparin therapy, while standard, can cause heparin-induced thrombocytopenia (HIT) in 1-5% of patients.
  • Direct thrombin inhibitors (DTIs) offer an alternative for anticoagulation, especially in HIT cases.

Purpose of the Study:

  • To discuss the role and efficacy of direct thrombin inhibitors in cardiovascular patients.
  • To review clinical trial data comparing DTIs with heparin in ACS and percutaneous coronary intervention (PCI).
  • To present an overview of bivalent and univalent DTIs used in cardiovascular care.

Main Methods:

  • Review of published clinical trials evaluating DTIs in cardiovascular patients.
  • Discussion of four specific DTIs: lepirudin, desirudin, bivalirudin, and argatroban.
  • Analysis of DTI characteristics, including mechanism, metabolism, and excretion.

Main Results:

  • DTIs demonstrate potent inhibition of thrombus formation and reduction of coronary events in ACS and PCI.
  • Lepirudin and desirudin are bivalent DTIs with renal excretion.
  • Bivalirudin is a bivalent DTI with rapid-chain metabolism, and argatroban is a univalent DTI with hepatic metabolism.

Conclusions:

  • Direct thrombin inhibitors are effective in managing cardiovascular patients, especially those with HIT.
  • R-hirudin is a suitable option for HIT management and facilitates warfarin conversion due to minimal prothrombin time alteration.
  • DTIs show excellent potency in inhibiting thrombus and reducing coronary events.

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