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This chapter reviews the anti-thrombin agents (also known as anti-coagulants), which include the heparins (unfractionated heparin and low-molecular heparin [i.e., enoxaparin]), direct thrombin inhibitors (i.e., bivalirudin), and factor Xa inhibitors (i.e., fondaparinux). The interest behind the use of anti-thrombin agents stems from the fact that ACS patients who are only treated with anti-platelet agents are still at risk of significant ischemic events. The clinical trial experience with these agents crosses several decades. This span includes an early era with relatively nonaggressive antiplatelet therapies (i.e., infrequent or no aspirin, thienopyridines, glycoprotein IIb/ IIIa inhibitors), or adjuvant therapies (i.e., statins). This earlier time period was also largely characterized by noninvasive therapy, which is not currently considered the standard of care for ACS patients. Accordingly, the substantial improvement in medical therapy and invasive management of patients with ACS makes interpretation of the early trial experience relatively difficult, compared with the newer cardiovascular agents. Our discussion will start with heparin, which is the oldest anti-thrombin agent in the care of ACS patients.
KeywordsPercutaneous Coronary Intervention Acute Coronary Syndrome Major Bleeding Unfractionated Heparin Direct Thrombin Inhibitor
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