Wykrzykowska Joanna J, Kathiresan Sekar, Jang Ik-Kyung
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
J Thromb Thrombolysis. 2003 Feb;15(1):47-57. doi: 10.1023/a:1026144518686.
Antithrombotic therapy has become the cornerstone of the treatment for atherosclerotic cardiovascular disease. Unfractionated heparin (UFH) has been the thrombin inhibitor of choice for decades. UFH, however, has its deficiencies. To overcome these problems several direct thrombin inhibitors (DTIs) have been developed. These agents are capable of inactivating clot-bound thrombin more efficiently, and provide more predictable and safer anticoagulation in patients with of acute coronary syndromes (ACS). The initial studies of hirudin and bivalirudin in the clinical settings of acute myocardial infarction (AMI), unstable angina (UA) and percutaneous coronary interventions (PCI) conducted in the early 1990s proved to be disappointing. As the knowledge of more appropriate use of these drugs progressed, there is a renewed interest in DTIs. Herein we will review the clinical studies assessing hirudin, bivalirudin and argatroban in the settings of AMI, UA and PCI.
抗栓治疗已成为动脉粥样硬化性心血管疾病治疗的基石。普通肝素（UFH）数十年来一直是首选的凝血酶抑制剂。然而，UFH存在其不足之处。为克服这些问题，已研发出几种直接凝血酶抑制剂（DTIs）。这些药物能够更有效地使与血栓结合的凝血酶失活，并为急性冠状动脉综合征（ACS）患者提供更可预测、更安全的抗凝作用。20世纪90年代初在急性心肌梗死（AMI）、不稳定型心绞痛（UA）和经皮冠状动脉介入治疗（PCI）临床环境中对水蛭素和比伐芦定进行的初步研究结果令人失望。随着对这些药物更合理使用的认识不断进步，人们对DTIs重新产生了兴趣。在此，我们将回顾评估水蛭素、比伐芦定和阿加曲班在AMI、UA和PCI环境中的临床研究。
