Direct thrombin inhibitors for non-ST-segment elevation acute coronary syndromes: what, when, and where?
BACKGROUND
Unfractionated heparin has been the cornerstone of antithrombin therapy in the treatment of non-ST-segment elevation acute coronary syndromes for more than a decade. Several new anticoagulants have emerged in recent years and have been studied extensively in patients with unstable coronary syndromes and in the percutaneous coronary intervention setting.


METHODS
Direct thrombin inhibitors comprise a family of agents with promising properties that offer several potential advantages over unfractionated heparin. Hirudin has been studied in patients with ST-elevation myocardial infarction, non-ST-elevation coronary syndromes, and coronary angioplasty. Bivalirudin has been studied in patients undergoing percutaneous coronary revascularization, with very promising efficacy and safety profile compared with unfractionated heparin.


RESULTS
The clinical trials of direct thrombin inhibitors in non-ST-elevation acute coronary syndromes and coronary angioplasty are reviewed.
Lincoff
A Michael
AM
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
D015906:Angioplasty, Balloon, Coronary; D001120:Arginine / Q000031:analogs & derivatives; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D024764:Hirudin Therapy; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D010446:Peptide Fragments / Q000627:therapeutic use*; D010875:Pipecolic Acids / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013449:Sulfonamides; D013577:Syndrome; D013917:Thrombin / Q000037:antagonists & inhibitors*; D015912:Thrombolytic Therapy / Q000379:methods*
D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban; C074619:bivalirudin