title: Bivalirudin is inferior to heparin in preservation of intraoperative autologous blood.
abstract: BACKGROUND
  Bivalirudin is used as an alternative to heparin in cardiac surgery, and may be superior to heparin with regard to platelet function. Bivalirudin however, is prone to cleavage by thrombin resulting in coagulation in areas of stasis.
  
  
  METHODS
  We compared the preservation of platelet function and the quality of anticoagulation in autologous blood of 26 cardiac surgical patients collected intraoperatively and anticoagulated ex vivo with either bivalirudin or heparin, with supplementation of bivalirudin over time and prevention of stasis.
  
  
  RESULTS
  We found in both preservatives a reduction in ADP-induced platelet aggregation response over a period of 105 minutes (median, IQR: 73-141) as measured by Multiplate®. Supplementation of additional bivalirudin (23 ± 1.1 μg/ml/hr) and prevention of stasis was not able to prevent thrombin generation. We found a 5-fold increase in levels of prothrombin fragment 1+2 in bivalirudin preserved autologous blood as compared to heparin preserved blood (F(1+2) levels median 8.9 nM [quartile percentiles 4.2-12.4] vs 1.3 nM [0.6-2.1], P=0.001 Mann-Whitney, n=10).
  
  
  CONCLUSIONS
  Our study suggests that preservation of platelet function in autologous blood anticoagulated with bivalirudin is not a suitable alternative to heparin.
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. r.c.g.huet@anest.umcg.nl
authors.forename: Rolf C G
authors.initials: RC
authors.lastname: Gallandat Huet
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cernak
authors.forename: Adrianus J
authors.initials: AJ
authors.lastname: de Vries
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001792:Blood Platelets / Q000166:cytology / Q000187:drug effects*; D001793:Blood Preservation / Q000379:methods*; D006493:Heparin / Q000494:pharmacology*; D006629:Hirudins / Q000494:pharmacology*; D006801:Humans; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism / Q000494:pharmacology*; D010974:Platelet Aggregation / Q000187:drug effects; D011516:Prothrombin / Q000378:metabolism; D011994:Recombinant Proteins / Q000494:pharmacology
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D006493:Heparin; C074619:bivalirudin