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Previous Volume 353:1028-1040 September 8, 2005 Number 10 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Direct thrombin inhibitors (DTIs) are a new class of anticoagulants that bind directly to thrombin and block its interaction with its substrates. Some DTIs — such as recombinant hirudins, bivalirudin, and ximelagatran, either alone or in combination with melagatran — have undergone extensive evaluation in phase 3 trials for the prevention and treatment of arterial and venous thrombosis. The evidence concerning the clinical applicability of other DTIs, such as argatroban and dabigatran, is limited to phase 2 studies. Four parenteral DTIs have been approved by the Food and Drug Administration (FDA) in North America: hirudin and argatroban for the treatment . . . [Full Text of this Article]

Mechanisms of Action

Coagulation Cascade and Generation of Thrombin

Differences from Heparins

Pharmacokinetics and Pharmacodynamics

Studies in Arterial Thrombosis

Acute Coronary Syndromes with or without Percutaneous Coronary Intervention

Percutaneous Coronary Intervention

Long-Term Treatment of Acute Coronary Syndromes

Atrial Fibrillation

Other Indications

Prevention of Venous Thromboembolism

Ximelagatran

Melagatran–Ximelagatran

Desirudin

Dabigatran

Perioperative Timing

Treatment of Established Venous Thromboembolism

Initial Treatment

Long-Term Secondary Prophylaxis

Heparin-Induced Thrombocytopenia

Remaining Issues

Direct Thrombin Inhibitors and Liver Function

Monitoring Activity

Conclusions

Source Information

From the Department of Vascular Medicine, Academic Medical Center, Amsterdam (M.D., S.M., H.R.B.); and the Department of Medicine and Aging, School of Medicine and Aging Research Center, Gabriele D'Annunzio University Foundation, Chieti–Pescara, Italy (M.D.).

Address reprint requests to Dr. Di Nisio at the Academic Medical Center, Department of Vascular Medicine F4-138, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands, or at m.dinisio@amc.uva.nl.

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