From Heparin to Bivalirudin: The Unresolved Question of Optimal Dosing in Pediatric Extracorporeal Support

Critically ill pediatric patients receiving extracorporeal support (n=6) in Türkiye who transitioned to bivalirudin due to persistent inability to maintain target aPTT ranges despite escalating doses of unfractionated heparin, development of thrombocytopenia after heparin exposure with clinical concern for heparin-induced thrombocytopenia, or citrate-related metabolic intolerance during continuous kidney replacement therapy.

Bivalirudin intravenous infusion at initial rates ranging from 0.02 to 0.1 mg/kg/h (with bolus administration applied inconsistently across patients), transitioned from unfractionated heparin or regional citrate anticoagulation.

Anticoagulation efficacy monitored using activated partial thromboplastin time (aPTT), including time to achieve the first therapeutic aPTT level and proportion of time spent within the target aPTT range.surrogate