Direct thrombin inhibitors in ACS

Abstract

Direct thrombin inhibitors (DTIs) offer several mechanistic advantages over heparin in the management and treatment of ACS, including ST-segment elevation myocardial infarction, and for percutaneous coronary intervention (PCI); these include free and clot-bound thrombin inhibition and consistent dosing. Managing anticoagulation and antithrombotic strategies involves minimizing ischemic events without increasing bleeding complications. DTIs have been studied extensively in many trials. In particular, bivalirudin has demonstrated a benefit in several trials by limiting the ischemic risk while reducing the risk of bleeding events. In this review, the pharmacology, results of clinical trials, and clinical indications for patients presenting with ACS who are undergoing medical therapy or PCI will be discussed.