ABSTRACT
A strong biological rationale for a therapeutic role of specific inhibitors of thrombin in the
management of acute coronary syndromes has led to the development of a new class of potent
antithrombotic agents that directly inhibit both fluid-phase and tissue-bound thrombin. Hirudin,
the prototype direct thrombin inhibitor, has been extensively evaluated in randomized trials in
unstable angina and acute myocardial infarction and, to a lesser extent, during percutaneous
coronary intervention. Although hirudin is superior to unfractionated heparin in reducing early
cardiac events during active treatment, it is also associated with an increased risk of major
bleeding. Thus, the role of hirudin in acute coronary syndromes remains to be clearly
established. The Direct Thrombin Inhibitor Trialists’ Collaboration is conducting an individual
patient data metanalysis of major randomized trials of direct thrombin inhibitors, which should
assist in further clarifying the role of hirudin in acute coronary syndromes.
