There are a number of direct thrombin inhibitors; the six most common are listed below:

Lepirudin (Refludan)

• Intravenous administration only
• Used for the treatment of HIT (heparin induced thrombocytopenia)
• Monitored by aPTT - goal is 1.5 to 3.0 times above baseline
• Renally cleared
• Not easily reversed

Argatroban

• Intravenous administration only
• Used for the treatment of HIT (heparin induced thrombocytopenia)
• Monitored by aPTT - goal is 1.5 to 3.0 times above baseline
• Dosing adjustment in hepatic dysfunction. NOT renally cleared

Bivalirudin (Angiomax)

• Intravenous administration only
• Short half-life of 25 minutes
• Used during PCI (percutaneous coronary intervention)
• May be used in ST elevation myocardial infarction

Dabigatran (Pradaxa)

• Oral administration
• Used for stroke prophylaxis in patients with non-valvular atrial fibrillation and atrial flutter
• Standard dose 150 mg PO twice daily
• Renally cleared. Dose reduction to 75 mg PO twice daily if creatinine clearance is 15-30 mL/min
• Not easily reversed
• No monitoring required if aPTT or PT due to predictable pharmacokinetics

Rivaroxaban (Xarelto)

• Actually a direct factor Xa inhibitor, not direct thrombin inhibitor
• Oral administration
• Used primarily for stroke prophylaxis in patients with non-valvular atrial fibrillation and atrial flutter. Also used for DVT prophylaxis after orthopedic surgery
• Standard dose is 20 mg PO once daily
• Renally cleared. Dose reduction to 15 mg PO daily with renal impairment. Not recommended in severe renal impairment
• Not easily reversed

Apixaban (Eliquis)