Why the study?
Few systemic anticoagulants are approved for mechanical heart valves beyond unfractionated heparin or vitamin K antagonists, despite emerging use of bivalirudin in other cardiac settings.
Bivalirudin may be a viable alternative anticoagulant for pediatric patients with mechanical heart valves who experience bleeding complications on unfractionated heparin.
Bivalirudin enabled anticoagulation in this pediatric dual mechanical valve case; leaves open safety and efficacy for wider use.
Despite advances in the development of systemic anticoagulants, there remain few agents approved for utilisation in patients with mechanical heart valves. Currently, recommendations for periprocedural and long-term anticoagulation in mechanical heart valves include unfractionated heparin or vitamin K antagonists, and there are some reports for off-label use of low-molecular-weight heparins. Emerging data on parenteral direct thrombin inhibitors, such as bivalirudin, have led to increased utilisation in both extracorporeal membrane oxygenation and ventricular assist devices. We present the case of a paediatric patient with rheumatic heart disease who had significant bleeding on unfractionated heparin who successfully received prolonged bivalirudin therapy in the setting of mechanical aortic and mitral heart valves.
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Branstetter et al. (2025) studied this question.
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