Complications in peripheral vascular interventions: emerging role of direct thrombin inhibitors

Unfractionated heparin is associated with a high rate of bleeding and thrombotic complications during peripheral vascular interventions (PVIs). Newer anticoagulants such as direct thrombin inhibitors might offer significant advantages over heparin. Early data with bivalirudin in the peripheral circulation are promising. Bivalirudin appears safe and effective when used during PVIs. Data with the use of other direct thrombin inhibitors (hirudin, r-hirudin, argatroban, and melagatran) in peripheral interventions are still lacking. Among these, argatroban and melagatran have pharmacologic properties that might offer some advantages in PVI, but further studies are needed to demonstrate their safety and effectiveness.