Cardiopulmonary bypass with bivalirudin in type II heparin-induced thrombocytopenia.
Cardiopulmonary bypass in patients with type II heparin induced-thrombocytopenia poses significant challenges. Inadequate pharmacokinetic profiles, monitoring, reversibility, and availability often limit alternative anticoagulation strategies. Bivalirudin, a semisynthetic direct thrombin inhibitor, was recently approved for use in patients undergoing percutaneous coronary interventions. Its unique properties, including a relatively short half-life, an anticoagulation effect that closely correlates with activated clotting time, and an alternate metabolic pathway for elimination, make bivalirudin an attractive agent for cardiopulmonary bypass in patients with type II heparin induced-thrombocytopenia. We report our experience using bivalirudin in 2 patients undergoing coronary artery bypass grafting.
Clayton
Stephanie B
SB
Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Acsell
Jeffrey R
JR
Crumbley
Arthur J
AJ
Uber
Walter E
WE
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000139:chemically induced*
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin