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 2024/04/18
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.