title: Adjunct bivalirudin dosing protocol for neuro-endovascular procedures.
abstract: OBJECTIVE
  To introduce a protocol for anticoagulation using bivalirudin in neuro-endovascular procedures.
  
  
  METHODS
  Three different bivalirudin dosing protocols were used in four consecutive patients undergoing neuro-endovascular procedures. Activated clotting time (ACT) was closely monitored to assess the effect of bivalirudin on ACT. Target ACT was set at 300-350 seconds.
  
  
  RESULTS
  The first dosing protocol led to largely supra-therapeutic ACT values. With the second protocol, ACT remained sub-therapeutic for 25 minutes (33% of monitoring time). The third protocol was applied to two patients and it showed the best results with the ACT being in the therapeutic range for 72% of the combined monitoring time and never exceeding 366 seconds.
  
  
  CONCLUSIONS
  The dosing of bivalirudin needs to be adjusted for the use in neuro-endovascular procedures. We are proposing a protocol that seems to provide safe and effective anticoagulation. The safety and efficacy of bivalirudin in neuroendovascular procedures will need to be further validated in future studies.
authors.affiliation: Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota.
authors.forename: Alexandros L
authors.initials: AL
authors.lastname: Georgiadis
authors.forename: Qaisar
authors.initials: Q
authors.lastname: Shah
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi