title: [Optimal dose of bivalirudin in dialysis patients at high risk of heparin-induced thrombocytopenia undergoing percutaneous coronary intervention: case report].
abstract: Bivalirudin is a direct thrombin inhibitor that has been approved for use in patients with or at risk for heparin-induced thrombocytopenia undergoing percutaneous coronary intervention. The efficacy of bivalirudin has been well documented in the setting of percutaneous coronary intervention, but there are only few data on its use in chronic dialysis-dependent patients. Bivalirudin is mainly eliminated enzymatically (80%) and to a lesser extent renally (20%). Nevertheless, in patients with chronic kidney disease a substantial increase in coagulation time and bleeding complications has been reported. Therefore, dosage adjustments may be necessary in patients with renal impairment. Dosing and monitoring recommendations in dialysis patients have not yet been established. We describe the case of a 77-year-old man with non-ST-elevation acute coronary syndrome complicated by heparin-induced thrombocytopenia and acute renal failure requiring dialysis treatment. During percutaneous coronary intervention, anticoagulant therapy with bivalirudin was administered at non-standard doses, though already documented in the literature.
authors: Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliero, Universitaria di Parma, Italy. francescanotarangelo@yahoo.it
authors: Maria Francesca
authors: MF
authors: Notarangelo
authors: Lucia
authors: L
authors: Coppini
authors: Federico
authors: F
authors: Bontardelli
authors: Francesca
authors: F
authors: Boffetti
authors: Luigi
authors: L
authors: Vignali
authors: Diego
authors: D
authors: Ardissino
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage*; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention; D011994:Recombinant Proteins / Q000008:administration & dosage; D006435:Renal Dialysis; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin