RT Book, Section A1 MANCL, ERIN E. A1 VOILS, STACY A. A2 Cohen, Henry SR Print(0) ID 1112260081 T1 Direct Thrombin Inhibitors T2 Casebook in Clinical Pharmacokinetics and Drug Dosing YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071628358 LK accesspharmacy.mhmedical.com/content.aspx?aid=1112260081 RD 2024/10/05 AB Intravenous (IV) direct thrombin inhibitors (DTIs), including argatroban, bivalirudin, and lepirudin have been developed and evaluated for the treatment of heparin-induced thrombocytopenia (HIT), acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and venous thromboembolism (VTE). DTIs exert their anticoagulant effect by binding directly to thrombin, thereby inhibiting both soluble and fibrin-bound thrombin.1 The direct binding to thrombin produces an anticoagulant effect independent of antithrombin (AT) activity. The ability to bind to fibrin-bound thrombin may be particularly advantageous in the setting of an active clot, such as a coronary thrombosis, because fibrin-bound thrombin can stimulate further clotting activity. In addition, compared to heparin-based regimens, DTIs may offer a more predictable anticoagulant effect due to their lack of binding to other plasma proteins. Furthermore, DTIs are a mainstay therapy in patients with HIT because they are not associated with immune-mediated thrombocytopenia.