• Type: Anticoagulant (Direct thrombin inhibitor)
  • Dosage Forms: injectable solution, ready-to-use injectable
  • Dosage Strengths: injectable solution: 100mg/mL; ready-to-use injectable: 50mg/50mL 0.9% NaCl, 125mg/125mL 0.9% NaCl
  • Routes of Administration: IV
  • Common Trade Names: Acova

Adult Dosing

  • HIT with thrombosis: 2 mcg/kg/min IV infusion, titrate to aPTT 1.5-3x baseline value
  • Myocardial infarction: 100 mcg/kg IV bolus + 1-3mcg/kg/min IV infusion x 6-72 hours; goal aPTT 50-85 seconds
  • Cerebral thrombosis: 60 mg/day continuous IV infusion x 2 days, then 10mg IV BID x 5 days
  • Coronary thrombosis prophylaxis after PCI (in patients at risk for HIT): 350 mcg/kg IV bolus + 25 mcg/kg/min IV continuous infusion; titrate to maintain activated clotting time 300-450 seconds

Pediatric Dosing

Safety/efficacy not established

  • HIT: 0.75 mcg/kg/min IV infusion; titrate in increments of 0.1-0.25 mcg/kg/min to goal aPTT 1.5-3x baseline level

Special Populations

  • Pregnancy Rating: B
  • Lactation risk: Infant risk cannot be ruled out
  • Renal dosing: no adjustment
  • Hepatic dosing: more frequent dosage adjustments may be needed. For HIT treatment in moderate-severe liver disease, initial dose 0.5mcg/kg/min


  • Allergy to class/drug
  • Major bleeding

Adverse Reactions


  • Major bleeding: GI bleeding, retroperitoneal hemorrhage, intracranial hemorrhage, coronary artery hemorrhage, hematuria
  • Angina, coronary artery thrombosis, aortic valve stenosis, MI, cardiac arrest
  • Sepsis
  • Pulmonary edema


  • Hypotension
  • Chest pain
  • Nausea/vomiting, diarrhea
  • Headache, backache
  • Dyspnea
  • Fever


  • Half-life: 30-51min, prolonged in hepatic impairment
  • Metabolism: Hepatic
  • Excretion: Mostly fecal

Mechanism of Action

  • Binds to and directly inhibits thrombin


See Also