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Parenteral Anticoagulants: Direct Thrombin Inhibitors and Pentasaccharides

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Anticoagulation Therapy

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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.

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Authors and Affiliations

  1. Inpatient Pharmacy Department, University of New Mexico Hospital, Albuquerque, NM, USA

    Meghan L. Fletcher

  2. University of New Mexico College of Pharmacy, Albuquerque, NM, USA

    Allison E. Burnett

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  1. Meghan L. Fletcher
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  2. Allison E. Burnett
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Correspondence to Allison E. Burnett .

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Editors and Affiliations

  1. Associate Professor of Cardiology, Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York, USA

    Joe F. Lau

  2. Assistant Professor, Division of Internal Medicine, Frankel Cardiovascular Center at the University of Michigan, Ann Arbor, Michigan, USA

    Geoffrey D. Barnes

  3. Professor of Medicine and Pathology, Division of Hematology, Department of Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA

    Michael B. Streiff

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Fletcher, M.L., Burnett, A.E. (2018). Parenteral Anticoagulants: Direct Thrombin Inhibitors and Pentasaccharides. In: Lau, J., Barnes, G., Streiff, M. (eds) Anticoagulation Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-73709-6_4

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  • DOI: https://doi.org/10.1007/978-3-319-73709-6_4

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