The direct thrombin inhibitors: their role and use for rational anticoagulation.

Major clinical advantages are achieved when direct thrombin inhibitors are used in venous thromboembolism. These agents provide more reliable anticoagulant response patterns because they are not significantly bound to plasma proteins and few, if any, drug-drug interactions are seen. The studies to date confirm that not all direct thrombin inhibitors are the same. The new reversible, short-acting catalytic site-specific drugs provide an excellent safety profile and high degree of efficacy for the prophylaxis and treatment of venous thromboembolism and pulmonary embolic states. The availability of the oral prodrug ximelagatran allows reproducible, effective, and safe direct thrombin inhibition without the requirement for coagulation laboratory monitoring; it appears destined to be the oral anticoagulant of the future.