Table 3.

Pharmacodynamics and pharmacokinetics of anti-coagulants in ACS.

Drug	Mechanism		Half-life	Metabolism	Elimination	Onset	Notes
UFH	AT-III mediated factor Xa and thrombin inhibitor	IV or SC	1–2 h	Hepatic	Extra-renal at therapeutic doses	Immediate (IV), 30 min (SC)	Inactive on clot-associated thrombin Unpredictable bioavailability
Enoxaparin	AT-III mediated factor Xa and thrombin inhibitor	SC	5–7 h	Hepatic	Renal	3–5 h	Inactive on clot-associated thrombin More factor Xa selectivity
Fondaparinux	Indirect factor Xa inhibitor	SC	17–21 h	Excreted largely as unchanged drug	Renal	2–3 h	Inactive on clot-associated thrombin
							Not for use in advanced CKD
Rivaroxaban	Direct factor Xa inhibitor	Oral	9–13 h	Hepatic	Renal and gastrointestinal	2–4 h	Phase III trials underway
Apixaban	(−) Factor Xa (direct)	Oral	12 h		Renal and biliary	3 h	Phase III trials underway
Otamixaban	(−) Factor Xa (direct)	IV	2–3 h		Biliary	Immediate	Phase III trials underway
Bivalirudin	Direct thrombin inhibitor, reversible	IV	25 min	Plasma proteases	Renal	Immediate	Inhibits clot-associated thrombin
Dabigatran	Direct thrombin inhibitor, reversible	Oral	12–17 h	Hepatic and plasma	Renal and gastrointestinal	1 h	Pro-drug, low bioavailability