Which medications in the drug class Direct thrombin inhibitors are used in the treatment of Acute Coronary Syndrome?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Direct thrombin inhibitors

Direct thrombin inhibitors bind directly to the anion binding site and the catalytic sites of thrombin to produce potent and predictable anticoagulation.

Hirudin (Lepirudin, Refludan)

Hirudin (Lepirudin, Refludan) is the prototype of direct thrombin inhibitors. Hirudin binds directly to the anion binding site and the catalytic sites of thrombin to produce potent and predictable anticoagulation. Currently, hirudin is indicated only in patients who are unable to receive heparin because of heparin-induced thrombocytopenia.

Bivalirudin (Angiomax)

Bivalirudin (Angiomax) is a synthetic analogue of recombinant hirudin. It inhibits thrombin and is used for anticoagulation in unstable angina in patients undergoing PTCA. Potential advantages over conventional heparin therapy include more predictable and precise levels of anticoagulation, activity against clot-bound thrombin, absence of natural inhibitors (eg, platelet factor 4, heparinase), and continued efficacy following clearance from plasma (because of binding to thrombin).


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