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Commentary |

The Association of Direct Thrombin Inhibitor Anticoagulants With Cardiac ThrombosesDirect Thrombin Inhibitors and Cardiac Thromboses

Bruce L. Davidson, MD, MPH, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle WA.

CORRESPONDENCE TO: Bruce L. Davidson, MD, MPH, FCCP, 12209 Shorewood Dr SW, Burien WA 98146; e-mail: brucedavidson@pobox.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(1):21-24. doi:10.1378/chest.14-2028
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Direct thrombin inhibitor (anti-factor IIa) anticoagulants such as dabigatran and bivalirudin, now established for treatment and prevention of cardiac thromboembolism and VTE, have been repeatedly associated with a significantly increased frequency of thrombosis on abnormal cardiac endothelium when compared head-to-head with indirectly acting therapeutic anticoagulants in studies of sufficient patient number and duration. Although there is uncertainty as to the mechanism, the weight of evidence as a class effect warrants prescribing effective anticoagulants other than direct thrombin inhibitors.


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