Correlation of Bivalirudin Dose with Creatinine Clearance During Treatment of Heparin‐Induced Thrombocytopenia

Runyan, Courtney L; Cabral, Katherine P.; Riker, Richard R.; Redding, David C.; May, Teresa; Seder, David B.; Savic, Marizela; Hedlund, Jacquelyn; Abramson, Stuart; Fraser, Gilles L.

doi:10.1592/phco.31.9.850

Cited by 14 publications

(14 citation statements)

References 19 publications

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“…Based on these pharmacokinetic properties, bivalirudin has become an attractive treatment option for HIT. [25][26][27][28][29][30][31][32] Problem DTI dosage adjustment can be problematic, as underdosing can increase the risk of thrombosis and overdosing may increase the risk of bleeding. The use of dosing nomograms has been shown to improve the safety, efficacy, and efficiency of anticoagulant therapy.…”

mentioning

confidence: 99%

Development and implementation of a nurse-driven, sliding-scale nomogram for bivalirudin in the management of heparin-induced thrombocytopenia

Burcham

Abel

Gerlach

et al. 2013

American Journal of Health-System Pharmacy

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mentioning

confidence: 99%

Development and implementation of a nurse-driven, sliding-scale nomogram for bivalirudin in the management of heparin-induced thrombocytopenia

Burcham

Abel

Gerlach

et al. 2013

American Journal of Health-System Pharmacy

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“…9 For bivalirudin, the initial dose potentially used in the management of HIT is 0.12 to 0.15 mg/kg/h, but is adjusted downward in the critically ill, the presence of renal failure, or those on hemodialysis. 16,17 This is much lower than the dose recommended in the prescribing information, which is for use in the setting of PCI. 3 Since bivalirudin is removed during hemodialysis, samples for aPTT testing should not be collected during or within a few hours after completion of dialysis.…”

Section: Dosing and Monitoring Of Dti: Heparin-induced Thrombocytopeniamentioning

confidence: 91%

“…[12][13][14][15] Bivalirudin can be used in patients with renal dysfunction, including those receiving dialysis when appropriately dose adjusted. 16,17 The pharmacokinetic half-life of bivalirudin can vary from 25 minutes to 3.5 hours depending on the degree of renal dysfunction. 15 Given the relatively short 25-minute half-life 11 and unique method of clearance, bivalirudin can also be used in patients with liver dysfunction.…”

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confidence: 99%

Laboratory Monitoring of Parenteral Direct Thrombin Inhibitors

Cott

Roberts

Dager

2017

Semin Thromb Hemost

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Argatroban and bivalirudin are parenteral direct inhibitors of the activity of thrombin, but, unlike heparin, can inhibit both soluble as well as clot-bound thrombin. These agents do not require antithrombin as a cofactor for activity. The parenteral direct thrombin inhibitors (DTIs) can be used in a variety of settings, including heparin-induced thrombocytopenia (HIT) or an allergy to heparin, and patients requiring anticoagulation for an invasive cardiovascular intervention. Both agents have a relatively short half-life in patients without organ system failure and are typically administered by continuous infusion. Argatroban is primarily eliminated by the liver, while bivalirudin is removed by a combination of proteolytic cleavage by thrombin and renal clearance mechanisms. Several laboratory tests are available for monitoring the anticoagulant effects of the DTIs: the activated partial thromboplastin time (aPTT) and the activated clotting time (ACT) are the most commonly used assays, but on occasion, the thrombin time may be useful. Other coagulation assays such as the dilute thrombin time (dTT), chromogenic anti-IIa assays, and the ecarin clotting time (ECT) can be used. The intensity of anticoagulation with DTIs depends on the indication for use. For patients with HIT, the target aPTT is 1.5 to 3.0 and 1.5 to 2.5 times the patient's baseline value for argatroban and bivalirudin, respectively. DTI anticoagulation used during percutaneous coronary intervention can be measured using ACT. Both DTIs may cause an elevation in the international normalized ratio depending on their plasma concentration. This article will review the use of parenteral DTIs and related laboratory assays for assessing the anticoagulant effect of these drugs.

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“…Bivalirudin has a short half‐life, helping make it suitable for use in ECMO. However, bivalirudin has no reversal agent, requires dose modification in renal impairment, and is significantly more expensive than heparin 119,120 . While bivalirudin is hailed as being a simpler alternative to heparin, the dose range described in the literature is 0.05 mg/kg/h to 1.6 mg/kg/h, with a range extending up to 2 mg/kg/h being anecdotally shared via correspondence between the authors and clinicians with experience using bivalirudin, making the relative dose range far larger than for heparin 121‐123 .…”

Section: Anticoagulation: Drugs and Monitoringmentioning

confidence: 99%

Hematologic concerns in extracorporeal membrane oxygenation

Sniderman

Monagle

Annich

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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This ISTH “State of the Art” review aims to critically evaluate the hematologic considerations and complications in extracorporeal membrane oxygenation (ECMO). ECMO is experiencing a rapid increase in clinical use, but many questions remain unanswered. The existing literature does not address or explicitly state many pertinent details that may influence hematologic complications and, ultimately, patient outcomes. This review aims to broadly introduce modern ECMO practices, circuit designs, circuit materials, hematologic complications, transfusion‐related considerations, age‐ and size‐related differences, and considerations for choosing outcome measures. Relevant studies from the 2019 ISTH Congress in Melbourne, which further advanced our understanding of these processes, will also be highlighted.

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Correlation of Bivalirudin Dose with Creatinine Clearance During Treatment of Heparin‐Induced Thrombocytopenia

Abstract: Bivalirudin dosing requirements increased with increasing Clcr values. The high degree of variability suggests that dosing in individual patients will require careful titration to achieve adequate anticoagulation.

Cited by 14 publications

References 19 publications

Development and implementation of a nurse-driven, sliding-scale nomogram for bivalirudin in the management of heparin-induced thrombocytopenia

Development and implementation of a nurse-driven, sliding-scale nomogram for bivalirudin in the management of heparin-induced thrombocytopenia

Laboratory Monitoring of Parenteral Direct Thrombin Inhibitors

Hematologic concerns in extracorporeal membrane oxygenation

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