Parenteral Direct Thrombin Inhibitors

Direct thrombin inhibitors directly inhibit thrombin, which reduces coagulation.  Argatroban is used in the treatment of HIT and for patients who are at risk of HIT undergoing PCI.  Bivalirudin is derived from a chemical in leech saliva.  Bleeding is obviously a risk.

Class Drugs

• Argatroban

• Bivalirudin

• Desirudin

Class Mechanism of Action

Direct thrombin inhibitors

• Decreased thrombin activity reduces coagulation

Site of action of direct thrombin inhibitors in the coagulation cascade.

Class Applications

See individual drugs

Class Adverse Effects

Bleeding, can be life threatening

• No reversal agent

Drug Table

Drug Name	Application	Comments	Image
Argatroban	Treatment and prophylaxis of venous thromboembolism associated with HIT; PCI in patients at risk of HIT	Pharmacokinetics; Metabolized by the liver; Monitoring should be performed: aPTT; Half-life is short < 1hr	"Argo Movie" "Robe"
Bivalirudin	PCI in patients at risk of HIT	Compound derived from leech saliva; Pharmacokinetics; Half-life is short < 30 min; Renally eliminated	"Bivalve" "Ruby"
Desirudin	Prevention of DVT in hip replacement surgery		"Desire Udon noodles"