Published online Oct 16, 2019. doi: 10.5492/wjccm.v8.i6.87
Peer-review started: May 9, 2019
First decision: August 2, 2019
Revised: August 13, 2019
Accepted: September 5, 2019
Article in press: September 5, 2019
Published online: October 16, 2019
Core tip: In contrast to unfractionated heparin, direct thrombin inhibitors are not associated with heparin-induced thrombocytopenia or acquired antithrombin deficiency. Direct thrombin inhibitors, specifically bivalirudin and argatroban, are equally safe and possibly more efficacious than unfractionated heparin. Dosage and monitoring parameters are easily manageable and more predictable than unfractionated heparin. As extracorporeal membrane oxygenation increases in use, direct thrombin inhibitors may potentially be considered as a primary anticoagulant in patients with or without complications of unfractionated heparin.