L’IMPIEGO CLINICO DI UNA NUOVA CLASSE DI FARMACI ANTICOAGULANTI: GLI INIBITORI DIRETTI DELLA TROMBINA

The coagulation cascade, and particularly thrombin, plays a very important role in arterial and venousthrombosis. Thereby, it is clear that thrombin inactivation is an optimal strategy for thromboticdisease prevention and treatment. The direct thrombin inhibitors are a new class of anticoagulantdrugs directly binding thrombin and blocking its interaction with fibrinogen. The group of directthrombin inhibitors includes recombinant hirudin (lepirudin and desirudin), bivalirudin, melagatranand its oral precursor, ximelagatran, argotraban and dabigatran. These drugs have several advantagescompared to other anticoagulant drugs, and the particular pharmacokinetic properties of someof them could be very important for future management of thromboembolic prophylaxis.The efficacy and safety of these new drugs are evaluated in several clinical trials; however todayonly few clinical indications are available for the majority of them.