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Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physician Evidence-Based Clinical Practice Guidelines Online Only ArticlesParenteral Anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Section snippets
Heparin
More than 90 years ago, McLean1 discovered that heparin has anticoagulant properties. Brinkhous and associates2 then demonstrated that heparin requires a plasma cofactor to express its anticoagulant activity. In 1968, Abildgaard identified this cofactor as antithrombin III,3 which is now referred to as antithrombin. The major anticoagulant action of heparin is mediated by the heparin/AT interaction. The mechanism of this interaction was demonstrated in the 1970s.4, 5, 6 Heparin binds to
Direct Thrombin Inhibitors
In contrast to indirect anticoagulants, which require a plasma cofactor to exert their activity, direct thrombin inhibitors have intrinsic activity because they bind to thrombin and block its enzymatic activity. The currently approved direct thrombin inhibitors are hirudin, bivalirudin, and argatroban.
Acknowledgments
Author Contributions: As Topic Editor, Dr Garcia oversaw the development of this article, including any analysis and subsequent development of the information contained herein.
Dr Garcia: contributed as a Topic Editor.
Dr Baglin: contributed as a panelist.
Dr Weitz: contributed as a panelist.
Dr Samama: contributed as a panelist.
Financial/nonfinancial disclosures: In summary, the authors have reported to CHEST the following conflicts of interest: Drs Weitz and Garcia have served as consultants for
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Funding/Support: The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines received support from the National Heart, Lung, and Blood Institute [R13 HL104758] and Bayer Schering Pharma AG. Support in the form of educational grants was also provided by Bristol-Myers Squibb; Pfizer, Inc; Canyon Pharmaceuticals; and sanofi-aventis US.
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