Molecular Basis for the Resistance of Fibrin-Bound Thrombin to Inactivation by Heparin/Serpin Complexes

Despite advances in the treatment of venous thrombosis with the use of better heparin dosing regimens (Cruickshank et al., 1991), the treatment of arterial thrombosis remains problematic. Not only does heparin have limitations in patients with acute coronary syndromes, but also hirudin, a potent and specific inhibitor of α-thrombin (thrombin), is of limited efficacy in this patient group (GUSTO Investigators, 1996). Thus, when used alone or as …