ABSTRACT
Introduction As a class of anticoagulants for the prevention of ischemic complications among patients undergoing percutaneous coronary intervention (PCI), the direct thrombin inhibitors have enjoyed a renewed interest, despite the fact that the development of these agents extends back over nearly two decades. These agents inhibit all the actions of thrombin by direct binding to this molecule, and in some cases, their action is limited by subsequent catalytic degradation by thrombin. Clinical evidence with these agents have been acquired in the context of balloon angioplasty as well as coronary stenting, across a spectrum of patient risk profiles and in conjunction with various antiplatelet agents, with the bulk of these data in the context of bivalirudin therapy. This chapter summarizes the basic physiology of thrombin and discusses each of the direct thrombin inhibitors with respect to their clinical pharmacology, indications, and clinical trial evidence in the context of PCI.
