Document Detail

Management of patients with acute coronary syndromes: what is the clinical role of direct thrombin inhibitors?
MedLine Citation:
PMID:  12215055     Owner:  NLM     Status:  MEDLINE    
Despite important pharmacokinetic and biological advantages of direct thrombin inhibitors over heparin, early randomised trials failed to demonstrate a clear net clinical benefit of these agents compared with heparin because of a higher bleeding risk, particularly with hirudin, and only modest efficacy gains. More recently, however, a systematic review of the direct thrombin inhibitor trials based on individual patient data as well as the results of the 17 000-patient Hirulog Early Reperfusion or Occlusion (HERO)-2 trial have confirmed the superiority of both hirudin and bivalirudin over unfractionated heparin in patients with acute coronary syndromes and undergoing percutaneous coronary intervention. Ongoing trials should further clarify the role of bivalirudin in patients undergoing percutaneous coronary intervention in the context of glycoprotein IIb/IIIa inhibitor use, while additional studies are required to define the role of direct thrombin inhibitors used in conjunction with other newer antithrombotic and/or thrombolytic strategies in patients with acute coronary syndromes.
John W Eikelboom; John French
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Drugs     Volume:  62     ISSN:  0012-6667     ISO Abbreviation:  Drugs     Publication Date:  2002  
Date Detail:
Created Date:  2002-09-06     Completed Date:  2002-10-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7600076     Medline TA:  Drugs     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  1839-52     Citation Subset:  IM    
Department of Medicine, Thrombosis and Haemophilia Unit, University of Western Australia, Royal Perth Hospital, Australia.
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MeSH Terms
Acute Disease
Angioplasty, Transluminal, Percutaneous Coronary*
Antithrombins / pharmacology,  therapeutic use*
Clinical Trials, Phase II as Topic
Clinical Trials, Phase III as Topic
Coronary Disease / drug therapy*,  therapy
Randomized Controlled Trials as Topic
Thrombin / antagonists & inhibitors
Treatment Outcome
Reg. No./Substance:
0/Antithrombins; EC

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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