Direct Thrombin Inhibitors in Acute Coronary Syndromes

摘要: The acute coronary syndromes (ACS) represent a continuum of athereothrombotic diseases that result from near instantaneous platelet activation and the initiation coagulation cascade most often following plaque erosion/rupture. Due to central role thrombin in clot formation, many therapies have aimed at inhibiting action slow or reverse minimize morbidity ACS. While unfractionated heparin has been stalwart agent for management ACS, several unfavorable characteristics such as inability inhibit clot-bound vulnerability circulating inhibitors prompted search alternative agents. Direct (DTIs) were developed an effort effectively block prothrombotic effects without associated increase hemorrhagic events seen with use heparin. Early trials evaluating DTI hirudin unstable angina (UA) non-ST-elevation myocardial infarction (NSTEMI) largely disappointing. More recent data demonstrated significantly lower bleeding rates similar effect on ischemic endpoints DTI, bivalirudin, across spectrum As result, bivalirudin patients presenting UA, NSTEMI, STEMI is increasing. In this chapter, regarding ACS will be presented suggestions their specific clinical scenarios given.