Safety, Efficacy, and Dosing Requirements of Bivalirudin in Patients with Heparin‐Induced Thrombocytopenia

Abstract

Bivalirudin dosing requirements correlated with renal function; therefore, dosage reduction is required in patients with moderate or severe renal dysfunction. Starting bivalirudin at 0.15 mg/kg/hour in patients with Cl(cr) greater than 60 ml/minute, 0.08-0.1 mg/kg/hour in patients with Cl(cr) 30-60 ml/minute, and 0.03-0.05 mg/kg/hour in patients with Cl(cr) below 30 ml/minute or receiving continuous RRT is effective at achieving goal aPTT values in most patients.

Treatment and Prevention of Heparin-Induced Thrombocytopenia

“…[99][100][101] Fondaparinux: The highest quality of evidence supporting fondaparinux for treatment of HITT comes from one small prospective cohort with historical controls 97 and one retrospective cohort with historical controls 96 ( Table 12 97 reported that neither six patients with HITT who were treated with a weight-based dose of fondaparinux nor eight patients treated with DTIs (lepirudin or argatroban) experienced recurrent VTE or major bleeding. Grouzi et al 96 reported that neither 24 patients with HITT who were treated with a weight-based dose of fondaparinux nor a historical control group of 20 patients treated with lepirudin experienced recurrent VTE or major bleeding.…”

Use of Prolonged Bivalirudin Infusions Following Percutaneous Coronary Intervention

“…The use of bivalirudin in patients with heparin-induced thrombocytopenia has been described with a goal PTT of 1.5-2.5 times control but the doses used and duration of therapy cannot be compared to the use in PCI and the regimens and monitoring used are not readily extrapolated between the two indications [33].…”

Treatment options in heparin-induced thrombocytopenia

“…Bivalirudin is 20% renally metabolized; dose modifications have been suggested for patients with abnormal renal function (see Table 2) [78,87].…”

“…Case reports and small case series have described the use of bivalirudin in treating HIT patients [87,[91][92][93][94], but an adequate level of evidence is not established [87]. Bivalirudin cannot be recommended as a viable treatment option without formal study.…”