Chap 43: Direct thrombin inhibitors

Introduction
- binds to active site of thrombin - rather than through antithrombin like heparin
- hirudin

• leech saliva
• available as recombinant form as lepirudin
• used by surgeons to prevent microvascular thrombosis - reattaching digits
• lepirudin used in pt with HITS
• monitored using APTT

- bivalirudin

• rapid onset + offset
• short T1/2 - used in PTCA

- argatroban - like above, used in pt with HITS
- ximelagatran - oral agent, no monitoring needed