Direct thrombin inhibition during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia.
Patients with or at risk of heparin-induced thrombocytopenia (HIT) who are undergoing percutaneous coronary intervention (PCI) are at particular risk of thrombosis due to the prothrombotic nature of HIT and the endovascular disruption from PCI. Patients require aggressive anticoagulation during PCI, and alternative, nonheparin anticoagulation is recommended over heparin in patients with acute or previous HIT. Argatroban, bivalirudin, and lepirudin are nonheparin, fast-acting, parenteral direct thrombin inhibitors (DTIs). Multicenter, prospective studies have demonstrated that argatroban and lepirudin each reduce thrombosis in HIT and that argatroban and bivalirudin each provide adequate anticoagulation during PCI in patients with or at risk of HIT. We review current therapeutic practices with direct thrombin inhibitors in patients with or at risk of HIT during PCI, including individuals requiring periprocedural anticoagulation, and the factors influencing the choice of DTI in this setting.
Lewis
Bruce E
BE
Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA. blewis@lumc.edu
Hursting
Marcie J
MJ
D015906:Angioplasty, Balloon, Coronary; D000991:Antithrombins / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D004347:Drug Interactions; D017850:Economics, Pharmaceutical; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology; D006801:Humans; D010446:Peptide Fragments / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D010875:Pipecolic Acids / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013927:Thrombosis / Q000517:prevention & control*
D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban; C074619:bivalirudin; C083544:lepirudin