Direct thrombin inhibitors: pharmacology and application in intensive care medicine.
OBJECTIVE
Anticoagulation is part of the daily routine of intensive care physicians. As the possibilities of pharmacological anticoagulation are becoming more numerous and diverse, intensive care physicians have to be familiar with indications, contraindications, dosing, and reversal of many different substances. This paper presents an overview of the substance group of direct thrombin inhibitors (DTI) indicated for alternative anticoagulation in intensive care medicine.


METHODS
The review is a synopsis of scientific evidence, expert opinion, open forum commentary, and clinical feasibility data.


CONCLUSIONS
Due to their antithrombotic potential without direct activation of platelets, DTI could offer potential advantages over heparins and vitamin K antagonists in critically ill patients, especially regarding heparin-induced thrombocytopenia. Because of multiple organ dysfunction, organ failure, and comedications, simple extrapolation of results of medical to critically ill patients is not permissible. The fine line between thrombosis and bleeding in intensive care patients requires cautious dosing and close drug monitoring. Studies dealing with DTI in the intensive care setting are of utmost clinical interest.
Schaden
Eva
E
Department of Anesthesiology, General Intensive Care and Pain Management, Medical University of Vienna, Währinger Guertel 18-20, 1090, Vienna, Austria. eva.schaden@meduniwien.ac.at
Kozek-Langenecker
Sibylle A
SA
D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D006490:Hemostatics / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D013917:Thrombin / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D006490:Hemostatics; D013917:Thrombin