Preemptive Use of Bivalirudin for Urgent On-Pump Coronary Artery Bypass Grafting in Patients With Potential Heparin-Induced Thrombocytopenia

Cardiac Surgery and Heparin Induced Thrombocytopaenia (HIT): A Case Report and Short Review

“…Haemostasis with good clot formation was considered adequate for chest closure 80 min post bypass, consistent with literature reports [8].…”

“…Recent evidence has shown ACT readings in the 350-400 s range with blood bivalirudin levels below the 10-15 g/mL range necessary for cardiopulmonary bypass [22]. This and literature reports of clot formation [4,8] were the basis for our goal of ACT readings above 550 s. ACCP guidelines caution the use of platelet concentrates with HIT as these may precipitate thrombosis. A small study has demonstrated the safety in the use of platelets in this hypercoaguable state [20].…”

Cardiopulmonary Bypass

“…Two approaches have been used to anticoagulate patients with HIT. The fi rst is to use direct thrombin inhibitors such as bivalrudin [64,65], lepirudin, or argatroban [66,67]. Hypersensitivity reactions have been reported with lepirudin [68], and antibodies developed against lepirudin may cross-react with bivalrudin [69].…”

Bivalirudin: Pharmacology and Clinical Applications

“…Bivalirudin has been used in cardiac surgical patients with heparin-induced thrombocytopenia (HIT) or suspected HIT (4,17,29,38,56,58). Cardiopulmonary bypass leads to the development of heparin-dependent antibodies in about 25-50% of patients, particularly with continued UFH postoperatively (49).…”

“…The advantage of bivalirudin over heparin is also apparent in patients with a history of heparin-induced thrombocytopenia (HIT) (17,37,42). In the multicenter, prospective, open-label The Anticoagulant Therapy with Bivalirudin to Assist in the performance of PCI in patients with HIT (ATBAT) study (37), the safety and efficacy of bivalirudin in patients with HIT or HIT with thrombotic syndrome (HITTS) undergoing coronary intervention was evaluated.…”