Direct thrombin inhibitors pharmacology

Given that thrombin is the central mediator of coagulation and amplifies its own production, it is a natural target for pharmacologic intervention. Direct thrombin inhibitors (DTIs) bind thrombin and prevent interactions with its substrates (Fig. 7-7). Several injectable DTIs are approved for use in the United States including lepirudin, bivalirudin, arga-troban, and desirudin. Several oral DTIs are currently in... 

Gurm HS, Bhatt DL. Thrombin, an ideal target for pharmacological inhibition a review of direct thrombin inhibitors. Am Heart J 2005 I49 S43-S53. 

Linkins LA, Weitz Jl, Pharmacology and clinical potential of direct thrombin inhibitors, Curr Pharm Des 2005 ... 

The pharmacological treatment options for ACS include agents that either reduce oxygen demand (beta blockers) or increase oxygen supply (nitrates, potassium channel activators, calcium channel blockers) to the heart and antiplatelet (aspirin, ADP-receptor antagonists, GPIIb/llla receptor blockers) and antithrombin therapy (unfractionated heparin, low molecular weight heparin, direct thrombin inhibitors) (10). 

Bivalirudin is a direct thrombin inhibitor that has found utility for reducing the rate of acute reocclusion in patients treated with PCI. It is preferential to heparin in PCI when HIT is present. This drug is a derivative of hirudin, which is a dedicated thrombin inhibitor with no other in vivo activities of significance. The molecule is semisynthetic the C-terminal of hirudin is linked by a polyglycine spacer to the tetrapeptide region of the N-terminal that reacts with the thrombin active site (22). It is monitored by the activated clotting time test. Its pharmacologic properties are shown in Table I. 

Callas D, Fareed J (1995). Comparative pharmacology of site directed antithrombin agents. Implication in drug development. Thromb. Haemostasis. 74 473-781. Hursting M J, Alford K L, Becker J P, et al. (1997). Novastan A small-molecule, direct thrombin inhibitor. Sem. Thromb. Hemostasis. 23 503-516. 

White CM, Thrombin-directed inhibitors pharmacology and clinical use, Am Heart J 2005 I49 S54-S60. 

Pharmacology Lepirudin (rDNA), a recombinant hirudin derived from yeast cells, is a highly specific direct inhibitor of thrombin. 

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