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

J Cardiothorac Vasc Anesth. 2020 Aug;34(8):2215-2223. doi: 10.1053/j.jvca.2020.01.020. Epub 2020 Jan 21.

Abstract

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. This drug circumvents certain problems with heparin administration, such as heparin resistance and heparin-induced thrombocytopenia, but it comes with additional challenges. In this manuscript, the authors review the literature on the emerging role of bivalirudin in pediatric cardiac surgery, including its use with cardiopulmonary bypass surgery, extracorporeal membrane oxygenation, ventricular assist devices, and interventional cardiology. Moreover, they provide an overview of bivalirudin's pharmacodynamics and monitoring methods.

Keywords: ECMO; anticoagulation; bivalirudin; cardiopulmonary bypass; pediatric cardiac surgery.

Publication types

  • Review

MeSH terms

  • Anticoagulants / adverse effects
  • Cardiac Surgical Procedures*
  • Cardiology*
  • Cardiopulmonary Bypass
  • Child
  • Heparin / adverse effects
  • Hirudins
  • Humans
  • Peptide Fragments
  • Recombinant Proteins

Substances

  • Anticoagulants
  • Hirudins
  • Peptide Fragments
  • Recombinant Proteins
  • Heparin
  • bivalirudin