The Use of Bivalirudin in Pediatric Cardiac Surgery and in the Interventional Cardiology Suite

Goswami, Dheeraj; DiGiusto, Matthew; Wadia, Rajeev; Barnes, Steve D.; Schwartz, Jamie Mc Elrath; Steppan, Diana; Nelson-McMillan, Kristen; Ringel, Richard; Steppan, Jochen

doi:10.1053/j.jvca.2020.01.020

Cited by 8 publications

(7 citation statements)

References 40 publications

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“…Infusion rates required to achieve a target concentration of 13 mg L −1 are less than those reported in clinical practice. Practitioners currently initiate bivalirudin at 2.5 mg kg −1 h −1 in children and either titrate infusion rate or give incremental bolus drug to achieve an ACT longer than 400 s. 22,23 Consequent reported infusion rates are closer to that proposed for a target concentration of 15 mg L −1 . Argueta-Morales et al, 24 Almond et al, 25 Faella et al, 26 Bryant et al, 27 Kamata et al, 28 Dosing in neonates and infants younger than 1 year remains problematic.…”

Section: E X Tr Ap Ol Ati On Of Adult Dos E Reg Imens To Childrenmentioning

confidence: 99%

Dose estimation for bivalirudin during pediatric cardiopulmonary bypass

Wolstencroft

Arnold

Anderson

2021

Pediatric Anesthesia

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Bivalirudin has been proposed as an alternative to heparin to maintain anticoagulation during cardiopulmonary bypass. It is currently used for patients with anti-thrombin 3 deficiency and heparin resistance, heparin-induced thrombocytopenia with vascular thrombosis (HIT) and for those who have suffered anaphylaxis to protamine. It is considered safe to re-expose patients to heparin after a relatively short period (100 days) if HIT antibody titers have fallen to low or undetectable levels. 1 When surgery cannot be delayed and

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Section: E X Tr Ap Ol Ati On Of Adult Dos E Reg Imens To Childrenmentioning

confidence: 99%

Dose estimation for bivalirudin during pediatric cardiopulmonary bypass

Wolstencroft

Arnold

Anderson

2021

Pediatric Anesthesia

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“…preference for unfractionated heparin (UFH) as firstline anticoagulation, bivalirudin was previously used only in situations wherein UFH was ineffective or contraindicated (1,4). Its widespread use was also limited by the lack of a reversal agent.…”

mentioning

confidence: 99%

“…Bivalirudin is a direct thrombin inhibitor emerging as the preferred anticoagulation for thromboprophylaxis after ventricular assist device (VAD) implantation in pediatric patients (1–3). With a historical preference for unfractionated heparin (UFH) as first-line anticoagulation, bivalirudin was previously used only in situations wherein UFH was ineffective or contraindicated (1, 4). Its widespread use was also limited by the lack of a reversal agent.…”

mentioning

confidence: 99%

Bivalirudin or Unfractionated Heparin for Anticoagulation in Pediatric Patients on Continuous Flow Ventricular Assist Device Support: Single-Center Retrospective Cohort Study

Puri

Tunuguntla

Hensch

et al. 2022

Pediatric Critical Care Medicine

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Bivalirudin is a direct thrombin inhibitor that is being increasingly used for anticoagulation in children after ventricular assist device (VAD) implantation. While the data on bivalirudin use in pulsatile flow VADs are growing, reports on its use in patients on continuous flow (CF) VAD as well as comparisons of associated outcomes with unfractionated heparin (UFH) remain limited. DESIGN:Retrospective cohort study. SETTING: Single tertiary-quaternary referral center. PATIENTS: All patients less than 21 years old on CF-VAD support who received bivalirudin or UFH for anticoagulation between the years 2016 and 2020. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Clinical characteristics compared between the cohorts included time to target range of anticoagulation, markers of hemolysis, and prevalence of hemocompatibility-related adverse events such as major hemorrhagic complications, ischemic stroke, and pump thrombosis. In 42 unique patients (41 HeartWare HVAD [Medtronic, Minneapolis, MN], one HeartMate 3 LVAD [Abbott Laboratories, Abbott Park, IL]) during the study period, a total of 67 encounters of IV anticoagulation infusions (29 UFH and 38 bivalirudin) were retrospectively reviewed. In comparison with use of UFH, bivalirudin was associated with lesser odds of major bleeding complications (odds ratio [OR], 0.29; 95% CI, 0.09-0.97; p = 0.038). We failed to identify any difference in odds of major thrombotic complications (OR, 2.53; 95% CI, 0.47-13.59; p = 0.450). Eight of the patients (28%) on UFH were switched to bivalirudin due to hemorrhagic or thrombotic complications or inability to achieve therapeutic anticoagulation, while two of the patients (5%) on bivalirudin were switched to UFH due to hemorrhagic complications. Bivalirudin was used for a "washout" in eight cases with concern for pump thrombosis-six had resolution of the pump thrombosis, while two needed pump exchange. CONCLUSIONS:Use of bivalirudin for anticoagulation in patients on CF-VAD support was associated with lesser odds of hemorrhagic complications compared with use of UFH. Bivalirudin "washout" was successful in medical management of six of eight cases of possible pump thrombosis.

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“…Stasis of blood rapidly depletes the local concentration of bivalirudin and triggers the coagulation process. 3 4…”

Section: Introductionmentioning

confidence: 99%

Perfusion Strategies for Bivalirudin Anticoagulation: AIIMS Protocol

Sharma

Hasija

Kapoor

2022

Journal of Cardiac Critical Care TSS

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Anticoagulation strategies for cardiac surgery are witnessing a change with the identification of serious limitations of heparin, including development of resistance in 3 to 13% of patients undergoing cardiac surgery and heparin-induced thrombocytopenia/thrombosis syndrome in 1 to 5.5% of patients. Heparin alternatives have a potential role in these scenarios. Bivalirudin, a reversible direct thrombin inhibitor, has an onset time of 2 to 4 minutes and half-life of 25 minutes, is eliminated mainly by a proteolytic mechanism, does not require antithrombin III for effect, and is nonimmunogenic. The considerations for extracorporeal circulation are peculiar with its use, and this article outlines the aspects of initiating, maintaining, and terminating cardiopulmonary bypass and extracorporeal membrane oxygenation with bivalirudin as the anticoagulant.

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The Use of Bivalirudin in Pediatric Cardiac Surgery and in the Interventional Cardiology Suite

Cited by 8 publications

References 40 publications

Dose estimation for bivalirudin during pediatric cardiopulmonary bypass

Dose estimation for bivalirudin during pediatric cardiopulmonary bypass

Bivalirudin or Unfractionated Heparin for Anticoagulation in Pediatric Patients on Continuous Flow Ventricular Assist Device Support: Single-Center Retrospective Cohort Study

Perfusion Strategies for Bivalirudin Anticoagulation: AIIMS Protocol

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