Evaluation of direct thrombin inhibitors during a critical heparin shortage
AbstractA recent heparin shortage related to an outbreak of African Swine Flu in China led to substantial increase in the use of direct thrombin inhibitors (DTI) as an alternative. We evaluated the safety and efficacy of DTIs by assessing the anticoagulation assays within the initial 48  h of therapy comparing before and during shortage. A retrospective evaluation of bivalirudin and argatroban was conducted at a single center before (May 24, 2018 through August 25, 2019) and during heparin shortage (August 26, 2019 through February 20, 2020). The primary outcome was time to first therapeutic activated partial thrombop...
Source: Journal of Thrombosis and Thrombolysis - January 5, 2021 Category: Hematology Source Type: research

Bivalirudin and Alteplase for Pulmonary Embolism Requiring Veno-Arterial Extracorporeal Membrane Oxygenation in an Adolescent.
We present a 17-year-old patient who was admitted to a pediatric cardiac intensive care unit with saddle PE requiring emergent VA-ECMO support because of cardiovascular collapse. Despite anticoagulation with bivalirudin and receiving systemic thrombolysis with alteplase, the clot burden was persistent with minimal improvement in right ventricular function. We proceeded to catheter thrombolysis while on VA-ECMO. This ultimately led to a successful resolution of the PE and allowed for weaning off VA-ECMO. PE is rare in children compared with adults, and pediatricians may be unaware of therapies becoming increasingly used in ...
Source: Journal of Extra-Corporeal Technology - December 23, 2020 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

A Review of Bivalirudin for Pediatric and Adult Mechanical Circulatory Support
AbstractAs the use of mechanical circulatory support has increased in volume and complexity, anticoagulation remains an intricate component of a patient ’s pharmacotherapy plan. Traditionally, heparin has been the primary anticoagulant utilized because of its ease of titration and  familiarity of use. More recently, bivalirudin, a direct thrombin inhibitor, has attracted attention as a potential alternative to traditional therapy. While labeled f or use in percutaneous coronary interventions, it is utilized off-label for heparin-induced thrombocytopenia and mechanical circulatory support. A literature search ide...
Source: American Journal of Cardiovascular Drugs - November 10, 2020 Category: Cardiology Source Type: research

Coronary thrombosis due to heparin ‐induced thrombocytopenia after percutaneous coronary intervention: Easy to miss, uneasy to prevent
In case of unexplained post ‐PCI coronary thrombosis, a HIT should be always considered. A pragmatic approach with bivalirudin may be reasonable, even in absence of confirmed laboratory diagnosis. AbstractIn case of unexplained post ‐PCI coronary thrombosis, a HIT should be always considered. A pragmatic approach with bivalirudin may be reasonable, even in absence of confirmed laboratory diagnosis. (Source: Clinical Case Reports)
Source: Clinical Case Reports - November 7, 2020 Category: General Medicine Authors: Marco Mele, Massimo Iacoviello, Grazia Casavecchia, Lucia Tricarico, Natale Daniele Brunetti Tags: CASE REPORT Source Type: research

Prospective Exploratory Experience With Bivalirudin Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation
Objectives: Objective of this study was to determine if bivalirudin resulted in less circuit interventions than unfractionated heparin. A secondary objective was to examine associations between bivalirudin dose and partial thromboplastin time, international normalized ratio, and activated clotting time. Design: Prospective observational. Setting: Medical-surgical and cardiac PICUs. Patients: Neonatal and pediatric extracorporeal membrane oxygenation patients who received bivalirudin anticoagulation. Interventions: None. Measurements and Main Results: Twenty extracorporeal membrane oxy...
Source: Pediatric Critical Care Medicine - November 1, 2020 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Bivalirudin dosing during prolonged intermittent renal replacement therapy: a case report
AbstractAs patients transition between dialysis modalities, and from the intra- to the inter-dialytic period, medications with a narrow therapeutic index that are cleared in dialysis may require dose adjustments and close monitoring. Three cases of patients receiving bivalirudin while converting from continuous to prolonged intermittent renal replacement therapy are reported. Details provided include flow rates and ultrafiltrate volume. In these cases, it appears pre-emptive dose adjustments may be unwarranted, and clinicians should be aware of potential rebound after cessation of dialysis. (Source: Journal of Thrombosis and Thrombolysis)
Source: Journal of Thrombosis and Thrombolysis - October 17, 2020 Category: Hematology Source Type: research

Anticoagulation with temporary Impella device in patients with heparin-induced thrombocytopenia: A case series.
Abstract The Impella device is a percutaneous ventricular assist devices that requires administration of heparin via a continuous purge solution. Patients on Impella device support may experience hemolysis with accompanying thrombocytopenia generating suspicion for heparin-induced thrombocytopenia (HIT). However, data and recommendations for use of non-heparin anticoagulants with Impella device are lacking. Therefore, we performed a retrospective cohort analysis of patients requiring bivalirudin during Impella device support to describe the safety and efficacy of bivalirudin as an alternative anticoagulant during ...
Source: The International Journal of Artificial Organs - October 14, 2020 Category: Transplant Surgery Authors: Hohlfelder B, Militello MA, Tong MZ, Soltesz EG, Wanek MR Tags: Int J Artif Organs Source Type: research

Cerebral venous sinus thrombosis associated with spontaneous heparin-induced thrombocytopenia syndrome after total knee arthroplasty.
Authors: Hwang SR, Wang Y, Weil EL, Padmanabhan A, Warkentin TE, Pruthi RK Abstract Spontaneous heparin-induced thrombocytopenia (HIT) syndrome, characterized by clinical and serologic features of HIT despite the absence of proximate heparin exposure, can be triggered by total knee arthroplasty (TKA). A 56-year-old female receiving aspirin thromboprophylaxis post-TKA presented with aphasia and thrombocytopenia on post-operative day 11. Imaging studies revealed cerebral venous sinus thrombosis (CVST) and intravenous bivalirudin was initiated. Her serum tested strong-positive for IgG anti-PF4/polyanion complexes and ...
Source: Platelets - October 3, 2020 Category: Hematology Tags: Platelets Source Type: research

Management of Bivalirudin Anticoagulation Therapy for Extracorporeal Membrane Oxygenation in Heparin-Induced Thrombocytopenia: A Case Report and a Systematic Review
We present the first case of a Chinese patient who experienced HIT and received bivalirudin anticoagulation during ECMO. In addition, we present a systematic review for this topic. We searched PubMed, EMBASE, and Cochrane Library (up to April 20, 2020) for studies that included patients undergoing ECMO, presenting with HIT, requiring bivalirudin treatment, and reporting relevant outcomes. The literature review yielded 15 studies involving 123 patients, amongst whom 58 patients were confirmed or suspected HIT patients, and 76 patients received bivalirudin as an anticoagulant for ECMO. Twelve studies were included for quanti...
Source: Frontiers in Pharmacology - September 10, 2020 Category: Drugs & Pharmacology Source Type: research

Anticoagulation in critically ill patients on mechanical ventilation suffering from COVID-19 disease, The ANTI-CO trial: A structured summary of a study protocol for a randomised controlled trial
To assess the effect of anticoagulation with bivalirudin administered intravenously on gas-exchange in patients with COVID-19 and respiratory failure using invasive mechanical ventilation. (Source: Trials)
Source: Trials - September 7, 2020 Category: General Medicine Authors: Nadir Kharma, Stefan Roehrig, Ahmed Atef Shible, Moustafa Sayed Elshafei, Dema Osman, Ingi Mohamed Elsaid, Salma Faisal Mustafa, Asjad Aldabi, Osamah A.M. Smain and Marcus D. Lance Tags: Letter Source Type: research

Evaluation of Bivalirudin As an Alternative to Heparin for Systemic Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation*
Conclusions: This study showed that the use of bivalirudin in pediatric extracorporeal membrane oxygenation support is feasible, safe, reliable, and cost-effective in comparison to heparin. Further prospective randomized clinical trials are necessary to confirm our observations. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Bivalirudin Use During Pulmonary Vein Isolation in a Patient With Heparin-Induced Thrombocytopenia
No abstract available (Source: American Journal of Therapeutics)
Source: American Journal of Therapeutics - September 1, 2020 Category: Drugs & Pharmacology Tags: Letters to the Editor Source Type: research

Anticoagulation of Impella with a Bivalirudin Purge Solution
In this report, we describe two patients with heparin-induced thrombocytopenia (HIT) supported with an Impella using a bivalirudin-containing purge solution. Case 1 involved a 39-year-old man with cardiogenic shock, initially implanted with an intraaortic balloon pump, who developed HIT early in his hospital course. His worsening hemodynamics necessitated the placement of an Impella and later venoarterial extracorporeal membrane oxygenation until he eventually underwent durable left VAD implantation. Case 2 involved a 69-year-old man who had an Impella implanted for worsening cardiogenic shock. HIT was suspected shortly af...
Source: ASAIO Journal - September 1, 2020 Category: Medical Devices Tags: Case Reports Source Type: research

Post-the SAFARI STEMI study: Is there still a debate on radial vs. femoral access in STEMI?
Abstract Despite the seminal trials on radial versus femoral access for percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) showing reduced bleeding, major adverse cardiovascular events and mortality; these outcomes were attributed by some to low usage of bivalirudin and an unnecessarily higher dose of Heparin, combined with high usage of GP IIb/IIIa inhibitors, as well as to the use of larger bore catheters in the femoral groups. To prove the point, a study comparing TF with TR access was mooted( Lee et al., 2013) 3; with bivalirudin instead of heparin, preferably with use ...
Source: Indian Heart J - September 1, 2020 Category: Cardiology Authors: Chugh Y, Chugh S, Chugh SK Tags: Indian Heart J Source Type: research

Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19.
CONCLUSION: Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population. PMID: 32780853 [PubMed - as supplied by publisher] (Source: American Journal of Health-System Pharmacy : AJHP)
Source: American Journal of Health-System Pharmacy : AJHP - August 10, 2020 Category: Drugs & Pharmacology Authors: Sagardia LM, Daniels LM Tags: Am J Health Syst Pharm Source Type: research

Effect of bivalirudin on neointimal hyperplasia and endothelial proliferation in rabbit
ConclusionOur study demonstrates that bivalirudin significantly affects and prevents neointimal hyperplasia and endothelial cell proliferation. (Source: General Thoracic and Cardiovascular Surgery)
Source: General Thoracic and Cardiovascular Surgery - August 2, 2020 Category: Cardiovascular & Thoracic Surgery Source Type: research

A perioperative bivalirudin anticoagulation protocol for neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation
This study described our perioperative anticoagulation protocol and evaluated the relationship of bivalirudin dose to activated partial thrombin time (aPTT) and thromboelastography reaction time (TEG-R) monitoring assays. (Source: Thrombosis Research)
Source: Thrombosis Research - July 24, 2020 Category: Hematology Authors: Christopher W. Snyder, Neil A. Goldenberg, Anh Thy H. Nguyen, C. Jason Smithers, David W. Kays Tags: Full Length Article Source Type: research

Using a Modified CPD Blood Bag to Store Blood from either ECMO or RRT Circuit Blood in Pediatric Patients.
Authors: Neal JR, Friedrich TP, Schears GJ, Cramer CH Abstract By adapting a citrate phosphate dextrose (CPD) whole blood storage bag, residual blood from a renal replacement therapy (RRT) circuit can be saved in pediatric patients, decreasing in donor exposure later. The techniques used for autologous preoperative blood storage are the basis of storing the RRT circuit blood. The CPD anticoagulant has a benefit of having a commonly used reversal agent for its anticoagulant properties, i.e., calcium. Also, unlike the traditional anticoagulants used in extracorporeal membrane oxygenation (ECMO), i.e., heparin, and di...
Source: Journal of Extra-Corporeal Technology - July 17, 2020 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Bivalirudin for Maintenance Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation for COVID-19
In its severe manifestation, coronavirus disease 2019 (COVID-19) compromises oxygenation in a manner that is refractory to maximal conventional support and requires escalation to extracorporeal membrane oxygenation (ECMO). Maintaining ECMO support for extended durations requires a delicately balanced anticoagulation strategy to maintain circuit viability by preventing thrombus deposition while avoiding excessive anticoagulation yielding hemorrhage —a task that is complicated in COVID-19 secondary to an inherent hypercoagulable state. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2020 Category: Anesthesiology Authors: Troy G. Seelhammer, Phillip Rowse, Suraj Yalamuri Tags: Case Report Source Type: research

Description of Bivalirudin Use for Anticoagulation in Pediatric Patients on Mechanical Circulatory Support.
Conclusion and Relevance: Bivalirudin dosing in ECMO and VAD patients is consistent with dosing seen in previous reports but may be higher in VAD patients. Comparative studies between heparin and bivalirudin are necessary to compare cost-effective outcomes for pediatric patients. PMID: 32590908 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)
Source: The Annals of Pharmacotherapy - June 25, 2020 Category: Drugs & Pharmacology Authors: Campbell CT, Diaz L, Kelly B Tags: Ann Pharmacother Source Type: research

Radial access first for PCI in acute coronary syndrome : Are we propping up a  straw man?
Radial access first for PCI in acute coronary syndrome : Are we propping up a straw man? Herz. 2020 Jun 16;: Authors: Marbach JA, Alhassani S, Wells G, Le May M Abstract Coronary angiography and percutaneous coronary intervention (PCI) represent the recommended revascularization strategy for patients presenting with acute coronary syndrome (ACS). However, periprocedural bleeding events, of which up to 50% are related to the access site, remain an important complication of PCI and are associated with higher costs, prolonged hospital stays, and increased mortality. Several randomized trials have dem...
Source: Herz - June 19, 2020 Category: Cardiology Tags: Herz Source Type: research

Guidance for anticoagulation management in venous thromboembolism during the coronavirus disease 2019 (COVID-19) pandemic in Poland: an expert opinion of the Section on Pulmonary Circulation of the Polish Cardiac Society.
Abstract The COVID -19 pandemic affects anticoagulantion not only for those infected with SARS-CoV-2, but also for most patients who require daily anticoagulant therapy and are facing substantial limitations in medical care these days. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has frequently been reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and hematological alterations. In the era of COVID-19 pandemic is strongly recommended for patients who require chronic anticoagulation to continue therapy to pr...
Source: Polish Heart Journal - June 7, 2020 Category: Cardiology Authors: Kosior DA, Undas A, Kopeć G, Hryniewiecki T, Torbicki A, Mularek-Kubzdela T, Windyga J, Pruszczyk P Tags: Kardiol Pol Source Type: research

Radial versus femoral and bivalirudin versus unfractionated heparin in vulnerable patients with acute coronary syndromes
Publication date: Available online 6 June 2020Source: Revista Española de Cardiología (English Edition)Author(s): Mattia Galli, Dominick J. Angiolillo (Source: Revista Espanola de Cardiologia)
Source: Revista Espanola de Cardiologia - June 6, 2020 Category: Cardiology Source Type: research

Bivalirudin Experience in a Heterogeneous Ventricular Assist Device Population
Ventricular assist devices (VADs) are an increasingly common therapy for end-stage heart failure across all ages as a bridge to recovery or transplant and more recently as destination therapy. With increasing experience and difficulties with establishing therapeutic heparin levels, we have begun to explore the effectiveness of direct thrombin inhibitors in this patient population. This is a retrospective review of all long-term VAD patients, both adult and pediatric, who were anticoagulated with bivalirudin between January 2009 and January 2016. The starting dose was 0.3 mg/kg/hr, and dose was titrated for a goal pa...
Source: ASAIO Journal - May 30, 2020 Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research

Age-specific differences in the in vitro anticoagulant effect of Bivalirudin in healthy neonates and children compared to adults
This study aimed to determine the age-specific in vitro effect of bivalirudin in children compared to adults. (Source: Thrombosis Research)
Source: Thrombosis Research - May 15, 2020 Category: Hematology Authors: Natasha Letunica, Xavier Busuttil-Crellin, Jessica Cowley, Paul Monagle, Vera Ignjatovic Tags: Full Length Article Source Type: research

[Heparin-Induced Thrombocytopenia after Total Knee Replacement].
Authors: Salášek M, Šlechtová J, Pavelk T Abstract Heparin-induced thrombocytopenia is a rare complication of treatment with both unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Antibodies against the complex heparin-platelet factor 4 are the main cause of pathogenesis, resulting in the activation of thrombocytes, coagulation, endothelium, monocytes, neutrophils and subsequent highly prothrombotic state. The prothrombotic state can result not only in venous but also in arterial thrombosis at different locations (which is manifested apart from venous thromboembolic d...
Source: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca - May 13, 2020 Category: Orthopaedics Tags: Acta Chir Orthop Traumatol Cech Source Type: research

A comparison of bivalirudin and heparin for patients on extracorporeal membrane oxygenation
Extracorporeal Membrane Oxygenation (ECMO) is a form of mechanical life support often used in refractory cardiogenic or respiratory failure. Contact of blood circulating through the artificial circuit causes activation of the coagulation cascade necessitating the use of systemic anticoagulation. Continuous heparin infusion has traditionally been the initial anticoagulation therapy of choice given the short half-life and reversibility. Heparin works by reversibly binding to anti-thrombin III which catalyzes the degradation of factors IIa and Xa [1]. (Source: Thrombosis Research)
Source: Thrombosis Research - April 11, 2020 Category: Hematology Authors: Matthew A. Brown, Farzad Najam, Elizabeth S. Pocock, Peter F. Munoz, Katherine A. Farrar, David P. Yamane Tags: Letter to the Editors-in-Chief Source Type: research

Use of Bivalirudin in Treatment of Acute Left Ventricular Assist Device Thrombosis: Case Series
Bivalirudin has been used in treatment of left ventricular assist device thrombosis (LVAD) however, outcomes remain unclear. (Source: The Journal of Heart and Lung Transplantation)
Source: The Journal of Heart and Lung Transplantation - March 31, 2020 Category: Transplant Surgery Authors: J. Janjua, P. Jewel-Ripp, J.H. Blabaum, D. Pham, R. Dhingra Tags: (1137) Source Type: research

Cost Comparison of Bivalirudin versus Unfractionated Heparin for Children on Left Ventricular Assist Devices
Intravenous unfractionated heparin (UFH) has been the traditional immediate post-operative anticoagulant for pediatric ventricular assist device (VAD) recipients. In recent years, bivalirudin has been increasingly used as an alternative agent and may confer advantages over UFH. However, bivalirudin may be cost-prohibitive, due to the price of the drug. The aim of this study was to compare early post-operative costs for patient cohorts receiving UFH versus bivalirudin. (Source: The Journal of Heart and Lung Transplantation)
Source: The Journal of Heart and Lung Transplantation - March 31, 2020 Category: Transplant Surgery Authors: C. Heyrend, S. Chen, J. Lee, R. Ensign, M. Profsky, J. Murray, E. Griffiths, L.J. May Tags: (1189) Source Type: research

Coagulation Monitoring Correlation with Bivalirudin Dosing in Pediatric Ventricular Assist Device Support
The use of bivalirudin has increased dramatically for primary thromboprophylaxis in pediatric paracorporeal ventricular assist device (VAD) support with limited data on optimal monitoring of effect. Partial thromboplastin time (aPTT) is commonly used for monitoring of bivalirudin, but can be impacted by line heparin, variability in assays and other patient factors. As such, we sought to examine the correlation of PTT to International Normalized Ratio (INR), as a possible monitoring tool for bivalirudin in in pediatric VAD patients. (Source: The Journal of Heart and Lung Transplantation)
Source: The Journal of Heart and Lung Transplantation - March 31, 2020 Category: Transplant Surgery Authors: C. Knoll, B. Blume, C. Ventresco, B. Hawkins, M. Ghbeis, K.P. Daly, C. VanderPluym Tags: (1191) Source Type: research

Twelve-month mortality from the “How Effective are Antithrombotic Therapies in Primary Percutaneous Coronary Intervention (HEAT-PPCI) Trial”
There is ongoing uncertainty regarding the safety and efficacy of unfractionated heparin and bivalirudin when used for systemic anticoagulation in patients undergoing primary percutaneous coronary intervention (PPCI). This paper reports 12-month mortality from the HEAT-PPCI randomised trial. (Source: International Journal of Cardiology)
Source: International Journal of Cardiology - March 31, 2020 Category: Cardiology Authors: Sarah R. Blake, Adeel Shahzad, Ian Kemp, Christine Mars Dip, Keith Wilson, Rod H. Stables Source Type: research

Bivalirudin Versus Heparin During Intervention in Acute Coronary Syndrome: A Systematic Review of Randomized Trials
(Source: Cardiovascular and Haematological Disorders - Drug Targets)
Source: Cardiovascular and Haematological Disorders - Drug Targets - March 1, 2020 Category: Cardiology Authors: Bhogal, Sukhdeep Mukherjee, Debabrata Bagai, Jayant Truong, Huu T. Panchal, Hemang B. Murtaza, Ghulam Zaman, Mustafa Sachdeva, Rajesh Paul, Timir K. Tags: Review article Source Type: research

The Use of Bivalirudin in Pediatric Cardiac Surgery and in the Interventional Cardiology Suite
Anticoagulation is an essential component for patients undergoing cardiopulmonary bypass or extracorporeal membrane oxygenation and for those with ventricular assist devices. However, thrombosis and bleeding are common complications. Heparin continues to be the agent of choice for most patients, likely owing to practitioners ’ comfort and experience and the ease with which the drug's effects can be reversed. However, especially in pediatric cardiac surgery, there is increasing interest in using bivalirudin as the primary anticoagulant. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 28, 2020 Category: Anesthesiology Authors: Dheeraj Goswami, Matthew DiGiusto, Rajeev Wadia, Sean Barnes, Jamie Schwartz, Diana Steppan, Kristen Nelson-McMillan, Richard Ringel, Jochen Steppan Tags: Review Article Source Type: research

Clinical Outcomes of Bivalirudin Versus Heparin in Elderly Patients Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Controlled Trials
AbstractPurposeThe aim of this study was to explore the safety and efficacy of bivalirudin in elderly patients undergoing percutaneous coronary intervention (PCI).MethodsAn electronic search was conducted for randomized controlled trials with outcomes of interest in the elderly ( ≥ 65 years of age). Pooled risk ratios (RR) and 95% confidence interval (CI) using random effects Der Simonian–Laird models were calculated. Primary outcomes were net adverse clinical events (NACE) and major bleeding events at 30 days. Secondary outcomes were major adverse cardiac events (MA CE) at 30 days. MACE, all...
Source: Cardiovascular Drugs and Therapy - February 25, 2020 Category: Cardiology Source Type: research

Adjuvant antithrombotic therapy in ST-elevation myocardial infarction: Contemporaneous Portuguese cross-sectional data
ConclusionsIn 2016, according to data from these national registries, almost all patients with STEMI were treated with aspirin and 76% with dual antiplatelet agents, mostly clopidogrel. GP IIb/IIIa inhibitors were used in few patients, and UFH was the most prevalent parenteral anticoagulant drug.ResumoIntroduçãoO tratamento do enfarte agudo do miocárdio com elevação do segment ST (EAMCSST) baseia-se na ativação da via verde coronária, na administração de terapêutica médica adjuvante e na reperfusão através de angioplastia prim&...
Source: Revista Portuguesa de Cardiologia - February 21, 2020 Category: Cardiology Source Type: research

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation
ConclusionsThis study suggests that UFH and bivalirudin are associated with similar rates of thrombosis, major bleeding, and mortality events in patients supported by ECMO. However, it was observed that bivalirudin consistently maintained aPTT within the therapeutic range in comparison to UFH. (Source: Journal of Cardiac Surgery)
Source: Journal of Cardiac Surgery - February 13, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Haya Kaseer, Matthew Soto ‐Arenall, Devang Sanghavi, John Moss, Robert Ratzlaff, Si Pham, Pramod Guru Tags: ORIGINAL ARTICLE Source Type: research

Efficacy and safety of bivalirudin vs heparin in patients with coronary heart disease undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials
Background: This meta-analysis is to evaluate the efficacy and safety of bivalirudin in patients with ST-elevation myocardial infarction (STEMI). Methods: PubMed, Cochrane Library, Embase, CNKI, CBMdisc, and VIP database were searched. Randomized controlled trial (RCT) was selected and the meta-analysis was conducted by RevMan 5.1. The primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) and the primary safety endpoint was the incidence of major bleeding. Secondary efficacy endpoints were myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stoc...
Source: Medicine - February 1, 2020 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Evaluation of intravenous direct thrombin inhibitor monitoring tests: Correlation with plasma concentrations and clinical outcomes in hospitalized patients
AbstractThe parenterally administered direct thrombin inhibitors (DTIs) argatroban and bivalirudin are effective anticoagulants for acute heparin-induced thrombocytopenia (HIT) treatment. The activated partial thromboplastin time (aPTT) has classically been used as the monitoring test to assess degree of anticoagulation, however concerns exist with using aPTT to monitor DTI therapy. In this observational study plasma samples from DTI treated patients were analyzed by aPTT, dilute thrombin time (dTT) and ecarin chromogenic assay (ECA) to delineate results into concordant and discordant groups. Discordant samples were furthe...
Source: Journal of Thrombosis and Thrombolysis - January 18, 2020 Category: Hematology Source Type: research

Pooling the Evidence at the Patient Level: End of the Bivalirudin Saga?
PMID: 31899923 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)
Source: Thrombosis and Haemostasis - January 2, 2020 Category: Hematology Authors: Capodanno D, Angiolillo DJ Tags: Thromb Haemost Source Type: research

Bivalirudin anticoagulation to overcome heparin resistance in a neonate with cerebral sinovenus thrombosis
Anticoagulation in a neonate is a challenge and the availability of anticoagulant options is extremely limited. Here we describe the use of a direct thrombin inhibitor, bivalirudin, in a full-term neonate with symptomatic cerebral sinovenous thrombosis complicated by bilateral thalamic hemorrhagic stroke and intraventricular hemorrhage, who could not be effectively treated with sodium heparin due to heparin resistance (HR) and showed thrombosis regression after start of bivalirudin treatment, without worsening of the hemorrhage. While the use of bivalirudin in neonates has been previously described, the indication of cereb...
Source: Blood Coagulation and Fibrinolysis - January 1, 2020 Category: Hematology Tags: CASE REPORTS Source Type: research

Recommendations for clinical laboratory testing for antithrombin deficiency; Communication from the SSC of the ISTH.
Abstract Hereditary deficiency of antithrombin, a natural anticoagulant, causes a thrombophilia with a high risk for venous thromboembolism. Guidance for laboratory testing to diagnose antithrombin deficiency include the use of an activity assay for initial testing, performing an antigen test and activity-to-antigen ratio when the activity level is low, using pediatric reference ranges until the age of 6 months, excluding acquired causes of low antithrombin (e.g. liver dysfunction, proteinuria, heparin, disseminated intravascular coagulation, thrombosis, surgery) or falsely normal/elevated results (e.g. argat...
Source: Thrombosis and Haemostasis - December 31, 2019 Category: Hematology Authors: Van Cott EM, Orlando C, Moore GW, Cooper PC, Meijer P, Marlar R, Subcommittee on Plasma Coagulation Inhibitors Tags: J Thromb Haemost Source Type: research

Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin.
ler S Abstract INTRODUCTION AND OBJECTIVES: Pump thrombosis is a serious left ventricular assist device complication, though there are no guidelines regarding its treatment. The main aim of this study was to describe a strategy of intravenous anticoagulation as the initial treatment in these patients and then to compare intravenous heparin with bivalirudin. METHODS: All consecutive patients who received a HeartWare left ventricular assist device from July 2009 to March 2019 were retrospectively analysed. Patients developing a pump thrombosis were selected, and treatment, outcomes and complications were record...
Source: The International Journal of Artificial Organs - December 29, 2019 Category: Transplant Surgery Authors: Bouzas-Cruz N, Gonzalez-Fernandez O, Ferrera-Durán C, Woods A, Robinson-Smith N, Tovey S, Jungschleger J, Booth K, Shah A, Parry G, MacGowan GA, Schueler S Tags: Int J Artif Organs Source Type: research

Myocardial Damage After ST-Segment Elevation Myocardial Infarction According to the Use of Bivalirudin or Heparin. A Cardiac Magnetic Resonance Substudy of the DANAMI3 trial.
Authors: Schoos MM, Nepper-Christensen L, Ahtarovski KA, Kyhl K, Göransson C, Holmvang L, Kelbæk H, Helqvist S, Høfsten DE, Køber L, Vejlstrup N, Lønborg J, Engstrøm T PMID: 31845893 [PubMed - as supplied by publisher] (Source: EuroIntervention)
Source: EuroIntervention - December 19, 2019 Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research

Monitoring bivalirudin therapy in children on extracorporeal circulatory support devices: Thromboelastometry versus routine coagulation testing
Bivalirudin is an alternative to heparin anticoagulation in infants and children in the setting of extracorporeal life support (ECLS). While activated partial thromboplastin time (aPTT) is widely accepted as the standard test to monitor bivalirudin therapy, the usefulness of thromboelastometry (ROTEM) to monitor bivalirudin infusion in the setting of ECLS is unknown. (Source: Thrombosis Research)
Source: Thrombosis Research - December 11, 2019 Category: Hematology Authors: Jun Teruya, Lisa Hensch, Karen Bruzdoski, Iki Adachi, Shiu-Ki Hui, Vadim Kostousov Tags: Full Length Article Source Type: research

Safety and efficacy of bivalirudin monotherapy in patients with non-ST-segment elevation acute coronary syndromes with positive biomarkers undergoing percutaneous coronary intervention: a report from the Acute Catheterization and Urgent Intervention Triage Strategy trial
Conclusion Compared with heparin plus GPI or bivalirudin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding at 30 days among patients with NSTE-ACS and positive biomarkers. (Source: Coronary Artery Disease)
Source: Coronary Artery Disease - December 10, 2019 Category: Cardiology Tags: Adjunctive Pharmacology Source Type: research

Individual Patient Data Pooled Analysis of Randomized Trials of Bivalirudin versus Heparin in Acute Myocardial Infarction: Rationale and Methodology.
CONCLUSION:  We have created a large individual patient database of bivalirudin versus heparin RCTs in patients with AMI undergoing PCI. This endeavor may help identify the optimal periprocedural anticoagulation regimen for patient groups with different relative risks of adverse ischemic versus bleeding events, including those with ST-segment and non-ST-segment elevation MI, radial versus femoral access, use of a prolonged bivalirudin infusion or glycoprotein inhibitors, and others. Adherence to standardized techniques and rigorous validation processes should increase confidence in the accuracy and robustness of the r...
Source: Thrombosis and Haemostasis - December 8, 2019 Category: Hematology Authors: Bikdeli B, McAndrew T, Crowley A, Chen S, Mehdipoor G, Redfors B, Liu Y, Zhang Z, Liu M, Zhang Y, Francese DP, Erlinge D, James SK, Han Y, Li Y, Kastrati A, Schüpke S, Stables RH, Shahzad A, Steg PG, Goldstein P, Frigoli E, Mehran R, Valgimigli M, Stone Tags: Thromb Haemost Source Type: research

Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction.
Authors: Rashid MK, Singh K, Bernick J, Wells GA, Hibbert B, Russo J, So DY, Le May MR, CAPITAL PCI Group Abstract BACKGROUND: A pharmacoinvasive strategy for ST-segment elevation myocardial infarction (STEMI) management combines the use of fibrinolysis with the routine transfer to coronary angiography, with percutaneous coronary intervention (PCI) if needed. This method reduces the risk of major adverse cardiovascular event (MACE) compared with fibrinolysis alone; however, it is associated with higher bleeding risk. We sought to assess the bivalirudin compared with unfractionated heparin (UFH) used during PCI as p...
Source: The Journal of Invasive Cardiology - December 2, 2019 Category: Cardiology Tags: J Invasive Cardiol Source Type: research

Risk Factors and Outcomes Associated with Prolonged Subtherapeutic Anticoagulation with Bivalirudin: a Retrospective Cohort Study
ConclusionsYounger age, normal renal function, and nonadherence to the dosing protocol when targeting therapeutic anticoagulation is associated with increased risk of failure to achieve ETA. This confers an elevated risk of thromboembolism when using bivalirudin for the management of HIT or other coagulation disorders. (Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy)
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - October 5, 2019 Category: Drugs & Pharmacology Authors: Libby A Orzel, Erik E. Abel, Danielle M. Blais, Tzu ‐Fei Wang, Kyle A Porter, Pamela K. Burcham Tags: ORIGINAL RESEARCH ARTICLE Source Type: research

Bivalirudin Use With Percutaneous Ventricular Assist Device in Suspected Heparin-Induced Thrombocytopenia.
PMID: 31510760 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)
Source: The Annals of Pharmacotherapy - September 10, 2019 Category: Drugs & Pharmacology Authors: Robinson ZS, Vega J, Fox NS Tags: Ann Pharmacother Source Type: research