Direct Thrombin Inhibitors

There are a number of direct thrombin inhibitors. The most common are as follows:

1. 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.

2. 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.

3. 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.

4. 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