title: Advances in antithrombotic therapy: novel agents.
abstract: Most of the clinical evaluation of the direct thrombin inhibitors has been in coronary artery disease. The recent clinical reports suggest that there is a narrower window of safety with recombinant hirudin than initially thought particularly when it is used in conjunction with thrombolytic agents and aspirin in acute myocardial infarction. The efficacy data, however, indicate that the direct thrombin inhibitors have great potential particularly in the initial management of patients with acute unstable angina and non-Q-wave infarction. There is much to learn regarding the mechanism of action, optimal dose, and optimal concomitant therapy in the use of direct thrombin inhibitors in the management of acute coronary ischaemia; and since hirudin and other direct thrombin inhibitors have so much potential in the management of acute coronary ischaemia, it is critical that dose-finding studies be performed to determine safe regimens of these agents to allow their evaluation in large-scale trials with important clinical outcomes. The direct thrombin inhibitors have also shown to have promise in the prevention of deep vein thrombosis in high-risk surgical patients. There is limited clinical data on the other novel anticoagulants which are currently being developed.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: A G
authors.initials: AG
authors.lastname: Turpie
authors.forename: J I
authors.initials: JI
authors.lastname: Weitz
authors.forename: J
authors.initials: J
authors.lastname: Hirsh
mesh_terms: D000789:Angina, Unstable / Q000188:drug therapy; D015906:Angioplasty, Balloon, Coronary; D000991:Antithrombins / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D017322:Clinical Trials, Phase II as Topic; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D015195:Drug Design; D004359:Drug Therapy, Combination; D004789:Enzyme Activation / Q000187:drug effects; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D024764:Hirudin Therapy; D006629:Hirudins / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D008074:Lipoproteins / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy; D017202:Myocardial Ischemia / Q000188:drug therapy; D010446:Peptide Fragments / Q000009:adverse effects / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011486:Protein C / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000639:trends*; D013924:Thrombophlebitis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D006629:Hirudins; D008074:Lipoproteins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011486:Protein C; D011994:Recombinant Proteins; C051928:lipoprotein-associated coagulation inhibitor; D001241:Aspirin; C074619:bivalirudin