Antithrombotic agents direct thrombin inhibitors

Contraindications are similar to those of other antithrombotic drugs, and hemorrhage is the most common and serious adverse effect. For all agents in this class, a CBC should be obtained at baseline and periodically thereafter to detect potential bleeding. There are no known agents that reverse the activity of direct thrombin inhibitors. 

The direct thrombin inhibitors, as their name implies, interact directly with the thrombin molecule" (Fig. 19-6). The agents in this class differ in terms of their molecular weight, chemical structure, and binding to the thrombin molecule. Unlike the UFH, the LMWHs, and fondaparinux, DTIs do not require antithrombin to have antithrombotic activity. They are capable of inhibiting both circulating and clot-bound thrombin, a potential advantage over UFH and the LMWHs. Eurther, DTIs have not been shown to induce immune-mediated thrombocytopenia and have been used widely for the treatment of HIT. 

Figure 7. Factor Xa targeting in the devdopment of new antithrombotic agents. Both the direct and indirect inhibitors of factor Xa is explored. Ihese agents are also potent inhibitors of thrombin generation at both the plasmatic and cellular sites.

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