Why the study?
Heparin has serious limitations in cardiac surgery, such as resistance and heparin-induced thrombocytopenia/thrombosis, requiring specialized considerations when using alternatives like bivalirudin during extracorporeal circulation.
This article provides a structured protocol for managing bivalirudin anticoagulation during extracorporeal circulation in cardiac surgery patients who cannot receive heparin.
Provides protocol guidance for bivalirudin in heparin-intolerant CPB/ECMO cases; leaves open prospective validation before routine adoption.
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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Sharma et al. (2022) studied this question.
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