title: Bivalirudin as an Alternative Anticoagulant for Cardiopulmonary Bypass During Adult Cardiac Surgery-A Change in Practice.
abstract: The referral of patients for open heart surgery, presenting with a history of heparin hypersensitivity instigated a multidisciplinary effort to find an alternative anticoagulant to heparin. The various options mentioned in the literature call for changes in the routine practice of open heart surgery on cardiopulmonary bypass. These changes involve mostly the perfusion setup and conduct on bypass and to a lesser extent the anesthetic and surgical practice. Nevertheless, the different professions involved in the cardiac surgical firm discussed the proposed changes in a multidisciplinary effort. A new protocol was drafted, endorsed, and executed. The authors highlight these changes and their successful use in the subsequent case study.
authors.affiliation: Clinical Perfusion Services, Mater Dei Hospital, Msida, Malta.
authors.forename: Peter
authors.initials: P
authors.lastname: Gatt
authors.affiliation: Department of General Surgery, Mater Dei Hospital, Msida, Malta.
authors.forename: Samuel Anthony
authors.initials: SA
authors.lastname: Galea
authors.affiliation: Department of Cardiac Surgery, Mater Dei Hospital, Msida, Malta.
authors.forename: Walter
authors.initials: W
authors.lastname: Busuttil
authors.affiliation: Clinical Perfusion Services, Mater Dei Hospital, Msida, Malta.
authors.forename: Charles
authors.initials: C
authors.lastname: Grima
authors.affiliation: Clinical Perfusion Services, Mater Dei Hospital, Msida, Malta.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Muscat
authors.affiliation: Clinical Perfusion Services, Mater Dei Hospital, Msida, Malta.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Farrugia
mesh_terms: D000368:Aged; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D004334:Drug Administration Schedule; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: adult cardiac surgery; anticoagulation; bivalirudin; cardiopulmonary bypass; protocol