PMID- 18957002
OWN - NLM
STAT- MEDLINE
DCOM- 20090123
LR  - 20161124
IS  - 0277-0008 (Print)
IS  - 0277-0008 (Linking)
VI  - 28
IP  - 11
DP  - 2008 Nov
TI  - Successful use and dosing of bivalirudin after temporary total artificial heart 
      implantation: a case series.
PG  - 1413-20
LID - 10.1592/phco.28.11.1413 [doi]
AB  - The temporary total artificial heart (TAH-t) has emerged as an effective bridge 
      to transplantation for individuals with biventricular failure. Implantation of a 
      TAH-t creates a hypercoagulable state requiring a multidrug approach that 
      includes low-dose unfractionated heparin (UFH) in order to minimize 
      thromboembolism. A concern with UFH is the development of heparin-dependent 
      antibodies, which develop in up to 50% of patients receiving the drug as part of 
      cardiopulmonary bypass. If UFH therapy continues postoperatively, the risk of 
      heparin-induced thrombocytopenia approaches 3%. Small investigations have 
      demonstrated that bivalirudin, given as a bolus of 0.75-1 mg/kg followed by an 
      infusion at 1.75-2.5 mg/kg/hour, is an effective alternative to UFH for 
      therapeutic anticoagulation during coronary artery bypass surgery, valve 
      replacement, or both. We describe a series of five adults (age range 24-58 yrs) 
      who received bivalirudin as an alternative to low-dose UFH after TAH-t 
      implantation. None of the patients had documented heparin-induced 
      thrombocytopenia. Treatment was started at the discretion of the treating 
      physician, and adjustments were based principally on the results of 
      thromboelastography. Additional general monitoring included activated partial 
      thromboplastin time, prothrombin time, international normalized ratio, 
      fibrinogen, D-dimer, platelet count, hemoglobin, hematocrit, and platelet 
      aggregation studies. Bivalirudin therapy was continued until successful warfarin 
      implementation. All five patients received bivalirudin in addition to standard 
      antithrombotic therapy. Bivalirudin treatment started at a dosage of 0.005 or 
      0.01 mg/kg/hour with titration to maintain normocoagulability, which occurred 
      (without concomitant warfarin therapy) within the dosage range of 0.01-0.02 
      mg/kg/hour. Duration of TAH-t implantation was a mean of 38.8 days (range 25-60 
      days), and bivalirudin was continued for a mean of 15.2 days (range 7-24 days). 
      No major hemorrhagic events occurred during treatment, and all patients 
      successfully transitioned to warfarin therapy. Low-dose bivalirudin, as an 
      alternative to UFH, maintained normocoagulability after TAH-t implantation. 
      Further investigation is warranted to define the role and dosing of bivalirudin 
      in this situation.
FAU - Crouch, Michael A
AU  - Crouch MA
AD  - South University School of Pharmacy, Department of Pharmacy Practice, 709 Mall 
      Boulevard, Savannah, GA 31406-4805, USA. mcrouch@southuniversity.edu
FAU - Kasirajan, Vigeshwar
AU  - Kasirajan V
FAU - Cahoon, William
AU  - Cahoon W
FAU - Katlaps, Gundars J
AU  - Katlaps GJ
FAU - Gunnerson, Kyle J
AU  - Gunnerson KJ
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/*administration & dosage/*therapeutic use
MH  - Antithrombins/*administration & dosage/*therapeutic use
MH  - Cardiomyopathy, Dilated/surgery
MH  - Heart Transplantation
MH  - *Heart, Artificial
MH  - Hirudins/*administration & dosage
MH  - Humans
MH  - Intraoperative Complications/blood/prevention & control
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/surgery
MH  - Partial Thromboplastin Time
MH  - Peptide Fragments/*administration & dosage/*therapeutic use
MH  - *Prosthesis Implantation
MH  - Recombinant Proteins/administration & dosage/therapeutic use
MH  - Young Adult
EDAT- 2008/10/30 09:00
MHDA- 2009/01/24 09:00
CRDT- 2008/10/30 09:00
PHST- 2008/10/30 09:00 [pubmed]
PHST- 2009/01/24 09:00 [medline]
PHST- 2008/10/30 09:00 [entrez]
AID - 10.1592/phco.28.11.1413 [pii]
AID - 10.1592/phco.28.11.1413 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2008 Nov;28(11):1413-20. doi: 10.1592/phco.28.11.1413.