Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery.
Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. It is contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) and heparin or protamine allergy. The safety and efficacy of the use of the direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery has been reported. However, there have been no reports on the treatment of heparin resistance with bivalirudin during CPB. In this review, we report the favorable outcome of our single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery.
Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada erick.mcnair@usask.ca.
E
E
McNair
Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada.
J-A
JA
Marcoux
Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
C
C
Bally
Department of Anesthesiology and Pain Management, College of Medicine and Saskatoon Health Region, Saskatoon, SK, Canada.
J
J
Gamble
Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada.
D
D
Thomson
D000925:Anticoagulants / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004351:Drug Resistance / Q000187:drug effects*; D006493:Heparin / Q000627:therapeutic use*; D006629:Hirudins; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
activated clotting time; bivalirudin; heparin; heparin concentration; heparin resistance