Direct thrombin inhibitors


There are a number direct thrombin inhibitors, the most common are as follows:

1. Lepirudin (Refludan)

  • Intravenous administration only.
  • Used for the treatment of HIT (heparin induced thrombocytopenia).
  • Monitored by aPTT - goal is 1.5 to 3.0 times above baseline.
  • Renally cleared.
  • Not easily reversed.

2. Argatroban

  • Intravenous administration only.
  • Used for the treatment of HIT (heparin induced thrombocytopenia).
  • Monitored by aPTT - goal is 1.5 to 3.0 times above baseline.
  • Dosing adjustment in hepatic dysfunction. NOT renally cleared.


3. Bivalirudin (Angiomax)

  • Intravenous administration only.
  • Short half-life of 25 minutes.
  • Used during PCI (percutaneous coronary intervention).
  • May be used in ST elevation myocardial infarction.

4. Dabigatran (Pradaxa)

  • Oral administration
  • Used for stroke prophylaxis in patients with non-valvular atrial fibrillation and atrial flutter.
  • Standard dose 150 mg PO twice daily.
  • Renally cleared. Dose reduction to 75 mg PO twice daily if creatinine clearance is 15-30 mL/min.
  • Not easily reversed.
  • No monitoring required if aPTT or PT due to predictable pharmacokinetics