Parenteral Anticoagulants: Direct Thrombin Inhibitors and Pentasaccharides

Chapter

Abstract

Unfractionated heparin (UFH), while very effective in preventing or treating arterial and venous thromboembolic events, possesses numerous disadvantages. These include a non-specific mechanism of action, high degree of non-specific binding to plasma components, unpredictable pharmacokinetics and pharmacodynamics, considerable inter- and intra-patient variability, a narrow therapeutic index, need for routine monitoring, and the potential for adverse effects. Additionally, some clinical situations preclude the use of UFH, such as immune-mediated heparin-induced thrombocytopenia (HIT). To address many of the drawbacks of heparin, alternative parenteral anticoagulants have been developed. In this chapter, we will discuss two groups of these alternative anticoagulants: pentasaccharides and parenteral direct thrombin inhibitors. Optimized safety and efficacy of these drugs require familiarity with their pharmacology, clinical utility, and practical management.

Keywords

Acute coronary syndrome Argatroban Bivalirudin Direct thrombin inhibitor Fondaparinux Heparin-induced thrombocytopenia Parenteral Pentasaccharide Percutaneous coronary intervention Superficial thrombophlebitis Venous thromboembolism 

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Inpatient Pharmacy DepartmentUniversity of New Mexico HospitalAlbuquerqueUSA
  2. 2.University of New Mexico College of PharmacyAlbuquerqueUSA

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