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The progress in molecular biology has stimulated interest in the structure and function of thrombin. It has improved the understanding of its central role in thrombogenesis and has clarified the molecular events of inhibitor binding. This development has resulted in the production of recombinant hirudins and the design of hirudin analogues. It has also allowed the molecular design of synthetic antithrombins and encouraged the development of these products for clinical use. All pharmacological aspects speak in favor of the use of the direct thrombin inhibitors as antithrombotic agents, especially in the potential indications in which thrombin plays a crucial role in the pathogenesis. If their apparent advantages in comparison to glycosaminoglycans can be shown effectively, the direct thrombin inhibitors may become the drug of choice for certain indications.