Key result
Pediatric bivalirudin requires higher infusion rates than adults to achieve target ACT during cardiopulmonary bypass.
Why the study?
While typical adult-based bivalirudin regimens during cardiopulmonary bypass are established, the appropriate dose in children remains unknown.
What is the appropriate bivalirudin dosing schedule for children undergoing surgery with cardiopulmonary bypass?
Population
Children undergoing surgery with cardiopulmonary bypass
Comparison
Bivalirudin dosing scaled using allometry vs adult-based regimens and published case reports
Design
Pharmacokinetic modeling and allometric scaling study
Authors
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May warrant higher initial pediatric dosing on CPB; leaves open prospective validation before practice change.
What is the appropriate bivalirudin dosing schedule for children undergoing surgery with cardiopulmonary bypass?
Bivalirudin infusion in children during cardiopulmonary bypass requires higher weight-based rates than adults to achieve target anticoagulation.
Wolstencroft et al. (2021) studied Children undergoing surgery with cardiopulmonary bypass. Bivalirudin vs. Adult dosing regimens was evaluated on Target bivalirudin concentration (13 mg/L) and activated clotting time > 400 s. Bivalirudin infusion in children requires higher rates than adults (3.5-4.5 mg/h/kg depending on weight) to achieve target activated clotting times >400 seconds during cardiopulmonary bypass.
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