What is the role of direct thrombin inhibitors in deep venous thrombosis (DVT) prophylaxis prior to orthopedic surgery?

Updated: Jan 28, 2021
  • Author: David A Forsh, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Drugs that act on the third stage of the coagulation cascade, the thrombin activity phase, include the direct thrombin inhibitors. These drugs specifically inactivate thrombin and are independent of ATII). Included in this group are the hirudins and their derivatives made by recombinant DNA techniques.

Originally, hirudin was isolated from leech salivary gland tissue. The new drugs include bivalirudin and lepirudin. A randomized, multicenter, double-blind study of hirudin versus heparin in patients with THRs demonstrated that DVT and proximal DVT rates were decreased substantially in the hirudin group.

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