New Anticoagulants Hirudin and Hirulog in the Treatment of Acute Coronary Syndromes

Thrombio plays a central role in thrombogenesis, It activates platelets, converts fibrinogen to tibrin, and activates factor XIII, which cross-links the fibrin thereby rendering it more resistant to lysis. Thrombin also arnplifies its own genertion by activating factors VII and V key coractors in the activation of factor X and prothrombin, respectively. Given the importance of thrombin in acute coronary syndromes the goal of most current antithrombotic strategies is to control thrombin generation or to inactivate thrombin. Although heparin has beeb the mainstay of antithrombotic treatment for arterial thrombosis, it has a number of funitations taht may be overcome by a new class of agents that interact directly with thrombin and block its activity. This review will focus on these new direct thrombin inhibitors and will a) review the mechanisms of action of the direct thrombin intibitors and other new aritithrombotics, and b) discuse the gromising experiental and clinical results with the direct thrombin inbibitors focusing on their use in acute coronary syndromes and coronary angioplasty.