Hirudin

Lepirudin

Bivalirudin 

Argatroban 

Dabigatran

***Direct thrombin inhibitors are anti-coagulant drugs***

• Direct binding to active site of thrombin 
• do NOT require other bindings proteins such as anti-thrombin-III 

• Not really used in the US but was approved for patients undergoing unstable angina w/coronay antioplasty 
• However in the US, ACS w/angioplasty is treated with:  Platelet glycoprotein IIb/IIIa receptor antagonists (eptifbatide, tirofiban, abcixmab) + aspirin + unfractionated heparin 

• Reversible binding to thrombin active site
• Does not require anti-thrombin III for anti-thrombotic effect 
• HIGHLY selective for thrombin.  Can bind to BOTH free and clot-associated thrombin 

• HIT induced thrombosis 
• Coronary angioplasty in patients with HIT

• Most widely used of the direct thrombin inhibitors 
• Acts through different binding sites to inactivate both free and fibrin bound thrombin 

• Prevent strokes in those with high risk 
• Thrombus prevention after surgery/hip or knee repalcement

• Bleeding
• The issue is that you cannot measure PT or aPTT times with these like you can for heparin or warfarin. Essentially no monitoring is available for the amount of clotting reduction  
• So serious bleeding has occured b/c of this