Direct thrombin inhibitor (DTI)
Direct, antithrombin-independent inhibition of thrombin (factor IIa)
- Binds thrombin's active site directly — no antithrombin requirement, unlike heparin
- Inhibits clot-bound AND free thrombin (heparin reaches only free thrombin)
- ➔ argatroban (ACOVA) — hepatically cleared; the HIT drug when kidneys fail
- ➔ bivalirudin (ANGIOMAX) — 25-min half-life; PCI anticoagulation
- Oral cousin: dabigatran (PRADAXA) — same mechanism, own deck
- No reversal agent for the IV agents; short half-life IS the safety strategy
No ballicule in the library carries this mechanism.