title: An assay to monitor bivalirudin levels on cardiopulmonary bypass.
abstract: Anticoagulation therapy for cardiopulmonary bypass in patients with recently diagnosed heparin-induced thrombocytopenia can be particularly challenging. Although heparin is the standard of care, in these situations anticoagulation is achieved with alternative agents such as direct thrombin inhibitors. Therapeutic concentrations are difficult to assess with direct thrombin inhibitors, and their use is riddled with bleeding and thrombotic complications. We report the successful use of a specific chromogenic antifactor IIa assay in a patient with heparin-induced thrombocytopenia who received anticoagulation therapy with bivalirudin during cardiopulmonary bypass for coronary artery bypass graft surgery.
authors: Department of Cardiothoracic Surgery, Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York 10065, USA. ars9001@med.cornell.edu
authors: Arash
authors: A
authors: Salemi
authors: Yash Pal
authors: YP
authors: Agrawal
authors: Manuel A
authors: MA
authors: Fontes
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D010446:Peptide Fragments / Q000008:administration & dosage*; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin