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Ann Thorac Surg 2004;78:2167-2169
© 2004 The Society of Thoracic Surgeons

Case report

Cardiopulmonary Bypass With Bivalirudin in Type II Heparin-Induced Thrombocytopenia

Stephanie B. Clayton, PharmDa, Jeffrey R. Acsell, CCPb, Arthur J. Crumbley, III, MD

Anthony G. Shackelford, CCPc, Walter E. Uber, PharmDa,*

a Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA
b Department of Cardiovascular Perfusion, Medical University of South Carolina, Charleston, South Carolina, USA
c Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA

Accepted for publication July 29, 2003.

* Address reprint requests to Dr Uber, Department of Pharmacy Services, 307 Rutledge Tower Annex, Medical University of South Carolina, 150 Ashley Ave, Charleston, SC 29425, USA
uberwe{at}musc.edu

Cardiopulmonary bypass in patients with type II heparin induced-thrombocytopenia poses significant challenges. Inadequate pharmacokinetic profiles, monitoring, reversibility, and availability often limit alternative anticoagulation strategies. Bivalirudin, a semisynthetic direct thrombin inhibitor, was recently approved for use in patients undergoing percutaneous coronary interventions. Its unique properties, including a relatively short half-life, an anticoagulation effect that closely correlates with activated clotting time, and an alternate metabolic pathway for elimination, make bivalirudin an attractive agent for cardiopulmonary bypass in patients with type II heparin induced-thrombocytopenia. We report our experience using bivalirudin in 2 patients undergoing coronary artery bypass grafting.




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Q. A Czosnowski, S. W Finks, and K. C Rogers
Bivalirudin for Patients with Heparin-Induced Thrombocytopenia Undergoing Cardiovascular Surgery
Ann. Pharmacother., September 1, 2008; 42(9): 1304 - 1309.
[Abstract] [Full Text] [PDF]


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