Side by side

1. 1.Binds the active site and exosite I of thrombin, blocking fibrin formation.
2. 2.Inhibits both free and clot-bound thrombin, unlike heparin.
3. 3.Its effect is reversible because thrombin slowly cleaves the peptide, so clotting recovers within about an hour of stopping.
4. 4.Does not require antithrombin, so it works when antithrombin is low.
5. 5.No risk of heparin-induced thrombocytopenia or the associated antibodies.

• Anticoagulation during percutaneous coronary intervention
• Patients with heparin-induced thrombocytopenia
• Acute coronary syndrome managed invasively
• Comparisons against heparin plus glycoprotein IIb/IIIa inhibitors

• Similar or lower rates of major bleeding than heparin plus a glycoprotein IIb/IIIa inhibitor in PCI trials
• Comparable ischaemic outcomes at 30 days
• Rapid loss of anticoagulant effect after stopping the infusion
• A higher rate of stent thrombosis in one large trial when bailout glycoprotein inhibitors were withheld

• Bleeding, including major and access-site bleeding
• Hypotension
• Back pain
• Nausea
• Rare allergic reactions
• Stent thrombosis if anticoagulation is inadequate

Research context only - a hospital anticoagulant. In the PCI trials the regimen was a 0.75 mg per kilogram intravenous bolus followed by an infusion of 1.75 mg per kilogram per hour for the duration of the procedure; trials measured major bleeding and major adverse cardiac events at 30 days and one year.

Research context only