PMID- 14642154
OWN - NLM
STAT- MEDLINE
DCOM- 20040227
LR  - 20041117
IS  - 0366-6999 (Print)
IS  - 0366-6999 (Linking)
VI  - 116
IP  - 11
DP  - 2003 Nov
TI  - Advances in antithrombin therapy for ST-elevation myocardial infarction.
PG  - 1760-3
AB  - Thrombin is a pivotal molecule in acute myocardial infarction (MI) because of its 
      extensive procoagulant and prothrombotic actions. Antithrombin therapy is an 
      important component of the pharmacotherapy for acute MI. The standard agent used 
      in clinical practice, unfractionated heparin (UFH), is associated with the 
      disadvantages of variable anticoagulant effect, inability to inhibit clot-bound 
      thrombin, neutralization by platelet factor 4, and the propensity to cause 
      thrombocytopenic complications. Novel thrombin inhibitors have been developed to 
      overcome these disadvantages. Although possessing the property of inhibiting both 
      fluid-phase and clot-bound thrombin, the direct thrombin inhibitor hirudin has 
      been shown to give marginal benefits over UFH as adjunct to fibrinolysis in 
      ST-elevation MI. Bivalirudin, another direct thrombin inhibitor, is able to 
      reduce reinfarction in patients treated with streptokinase and is a new 
      anticoagulant treatment option in this setting. The pharmacokinetic 
      characteristics of better availability, longer half-life, and dose-independent 
      clearance together with the ability of inhibiting both thrombin generation and 
      activity make the low-molecular-weight heparins (LMWHs) an attractive alternative 
      to UFH. The favorable benefit/risk profile of the LMWHs as adjunct to different 
      generations of fibrinolytic agents is setting the stage for larger clinical 
      trials to confirm their role as the antithrombin agent of choice for STEMI.
FAU - Chen, Wai-Hong
AU  - Chen WH
AD  - Department of Medicine, Queen Mary Hospital, Hong Kong, China.
FAU - Lau, Chu-Pak
AU  - Lau CP
LA  - eng
PT  - Journal Article
PT  - Review
PL  - China
TA  - Chin Med J (Engl)
JT  - Chinese medical journal
JID - 7513795
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - EC 3.4.21.5 (Thrombin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Electrocardiography
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy/physiopathology
MH  - Thrombin/*antagonists & inhibitors
RF  - 22
EDAT- 2003/12/04 05:00
MHDA- 2004/02/28 05:00
CRDT- 2003/12/04 05:00
PHST- 2003/12/04 05:00 [pubmed]
PHST- 2004/02/28 05:00 [medline]
PHST- 2003/12/04 05:00 [entrez]
PST - ppublish
SO  - Chin Med J (Engl). 2003 Nov;116(11):1760-3.