PMID- 25934498
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20161230
IS  - 1477-111X (Electronic)
IS  - 0267-6591 (Linking)
VI  - 31
IP  - 3
DP  - 2016 Apr
TI  - Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin 
      resistance during cardiopulmonary bypass-assisted cardiac surgery.
PG  - 189-99
LID - 10.1177/0267659115583525 [doi]
AB  - Heparin resistance (unresponsiveness to heparin) is characterized by the 
      inability to reach acceptable activated clotting time values following a 
      calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic 
      surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for 
      anticoagulation experience heparin resistance. Although UFH has been the "gold 
      standard" for anticoagulation, it is not without its limitations. It is 
      contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) 
      and heparin or protamine allergy. The safety and efficacy of the use of the 
      direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery 
      has been reported. However, there have been no reports on the treatment of 
      heparin resistance with bivalirudin during CPB. In this review, we report the 
      favorable outcome of our single-center experience with the alternative use of 
      bivalirudin in the management of anticoagulation of heparin unresponsive patients 
      undergoing coronary artery bypass graft surgery.
CI  - (c) The Author(s) 2015.
FAU - McNair, E
AU  - McNair E
AD  - Department of Pathology and Laboratory Medicine, College of Medicine, University 
      of Saskatchewan, Saskatoon, SK, Canada Department of Surgery, Division of Cardiac 
      Surgery, Saskatoon Health Region, Saskatoon, SK, Canada erick.mcnair@usask.ca.
FAU - Marcoux, J-A
AU  - Marcoux JA
AD  - Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, 
      Saskatoon, SK, Canada.
FAU - Bally, C
AU  - Bally C
AD  - Department of Pathology and Laboratory Medicine, College of Medicine, University 
      of Saskatchewan, Saskatoon, SK, Canada.
FAU - Gamble, J
AU  - Gamble J
AD  - Department of Anesthesiology and Pain Management, College of Medicine and 
      Saskatoon Health Region, Saskatoon, SK, Canada.
FAU - Thomson, D
AU  - Thomson D
AD  - Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, 
      Saskatoon, SK, Canada.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20150501
PL  - England
TA  - Perfusion
JT  - Perfusion
JID - 8700166
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Cardiac Surgical Procedures/*methods
MH  - Cardiopulmonary Bypass/*methods
MH  - Drug Resistance/*drug effects
MH  - Heparin/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Peptide Fragments/*therapeutic use
MH  - Recombinant Proteins/therapeutic use
OTO - NOTNLM
OT  - activated clotting time
OT  - bivalirudin
OT  - heparin
OT  - heparin concentration
OT  - heparin resistance
EDAT- 2015/05/03 06:00
MHDA- 2016/12/15 06:00
CRDT- 2015/05/03 06:00
PHST- 2015/05/03 06:00 [entrez]
PHST- 2015/05/03 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
AID - 0267659115583525 [pii]
AID - 10.1177/0267659115583525 [doi]
PST - ppublish
SO  - Perfusion. 2016 Apr;31(3):189-99. doi: 10.1177/0267659115583525. Epub 2015 May 1.