Use of bivalirudin as an anticoagulant during cardiopulmonary bypass.
Bivalirudin is a short-acting direct thrombin inhibitor that has been used in cardiac surgical patients with heparin-induced thrombocytopenia (HIT) or suspected HIT. Although no direct thrombin inhibitor is indicated for anticoagulation during cardiac surgery in patients with heparin-induced thrombocytopenia (HIT) or suspected HIT, use of heparin-alternatives are increasing as the awareness of HIT increases. Reports of anticoagulation with bivalirudin are sporadic, however, with variable dosing and management strategies. In this report, we describe our management techniques for cardiopulmonary bypass with bivalirudin based upon our personal experience. Although the reported clinical experience with bivalirudin in cardiac surgery is reviewed, operative techniques for the perfusionist/surgeon team are discussed in detail. We recognize that the use of bivalirudin during cardiopulmonary bypass is evolving and modifications of technique will undoubtedly occur as further data and experience accumulate.
Veale
James J
JJ
Carolina Cardiovascular and Thoracic Surgery Associates, Gaston Memorial Hospital, Gastonia, North Carolina 28054, USA.
McCarthy
Harry M
HM
Palmer
George
G
Dyke
Cornelius M
CM
D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D000991:Antithrombins / Q000494:pharmacology* / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D016903:Drug Monitoring; D005112:Extracorporeal Circulation / Q000379:methods*; D006629:Hirudins / Q000494:pharmacology; D006801:Humans; D010446:Peptide Fragments / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced
D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin