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Meshulami N, Murthy R, Meyer M, Meyer AD, Kaushik S. Bivalirudin anticoagulation for cardiopulmonary bypass during cardiac surgery. Perfusion 2023:2676591231221708. [PMID: 38084653 DOI: 10.1177/02676591231221708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Heparin is the primary anticoagulant for cardiopulmonary bypass (CPB) support during cardiac surgery. While widely used, ∼2% of cardiac surgery patients develop heparin-induced thrombocytopenia (HIT) and 4-26% develop heparin resistance. Bivalirudin is an alternative anticoagulant mainly used for percutaneous coronary interventions. Given the challenges associated with heparin anticoagulation, we conducted a review to explore the use of bivalirudin for CPB surgery. METHODS PubMed and Embase scoping review included 2 randomized controlled trials, a retrospective comparison study, 3 pilot studies, and 30 case reports. To provide a contemporary series, we searched for articles published from 2010 to 2023. Our review included studies from both adult and pediatric populations. RESULTS While data is limited, bivalirudin seems to supply similar effectiveness and safety as heparin for CPB anticoagulation. Across the three comparative studies, the heparin cohorts had a 0-9% mortality rate and 0-27% rate of major bleeding/reoperation compared to a 0-3% mortality and 0-6% major bleeding/reoperation rate for the bivalirudin cohorts. Bivalirudin was successfully used as an anticoagulant in a wide range of CPB surgeries (e.g., heart transplants, ventricular assisted device placements, and valve repairs). Successful patient outcomes were reported with bivalirudin infusion of ∼2 mg/kg/hour, activated clotting time monitoring (target >400 s or 2.5× baseline), use of cardiotomy suctions, minimization of stagnant blood, and post-bypass modified ultrafiltration. CONCLUSION Bivalirudin is a safe and effective anticoagulant for CPB, especially for patients with HIT or heparin resistance. Further comparative research is called for to optimize bivalirudin utilization for CPB during cardiac surgery.
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Affiliation(s)
- Noy Meshulami
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raghav Murthy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pediatric Cardiac Surgery, Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maisy Meyer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew D Meyer
- Division of Critical Care, Department of Pediatrics, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Shubhi Kaushik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Pediatric Critical Care, Department of Pediatrics, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York, NY, USA
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Girgis AM, Golts E, Humber D, Banks DA. Successful Use of Cangrelor and Heparin for Cardiopulmonary Bypass in a Patient With Heparin-Induced Thrombocytopenia and End-Stage Renal Disease: A Case Report. A A Pract 2019; 13:10-12. [PMID: 30688681 DOI: 10.1213/xaa.0000000000000969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heparin is the only well-established anticoagulant medication for cardiopulmonary bypass making selecting an alternative anticoagulant challenging in patients with heparin-induced thrombocytopenia. Other anticoagulant medications can cause significant postoperative bleeding, especially in patients with end-stage renal disease. We present a case of a 63-year-old woman requiring aortic valve replacement with a history of heparin-induced thrombocytopenia and end-stage renal disease. Cangrelor and heparin were successfully used during cardiopulmonary bypass, offering an option for anticoagulation management for a uniquely challenging patient population.
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Affiliation(s)
| | - Eugene Golts
- Cardiothoracic Surgery, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Doug Humber
- Department of Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
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Ivascu NS, Fitzgerald M, Ghadimi K, Patel P, Evans AS, Goeddel LA, Shaefi S, Klick J, Johnson A, Raiten J, Horak J, Gutsche J. Heparin-Induced Thrombocytopenia: A Review for Cardiac Anesthesiologists and Intensivists. J Cardiothorac Vasc Anesth 2019; 33:511-520. [DOI: 10.1053/j.jvca.2018.10.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 01/02/2023]
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Chernonosova VS, Gostev AA, Chesalov YA, Karpenko AA, Karaskov AM, Laktionov PP. Study of hemocompatibility and endothelial cell interaction of tecoflex-based electrospun vascular grafts. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2018.1525721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Vera S. Chernonosova
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, Russia
| | - Alexander A. Gostev
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Yuriy A. Chesalov
- Boreskov Institute of Catalysis, Siberian Branch, Russian Academy of Sciences, Novosibirsk, Russia
| | - Andrey A. Karpenko
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Alexander M. Karaskov
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Pavel P. Laktionov
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, Russia
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Cho JH, Parilla M, Treml A, Wool GD. Plasma exchange for heparin-induced thrombocytopenia in patients on extracorporeal circuits: A challenging case and a survey of the field. J Clin Apher 2018; 34:64-72. [DOI: 10.1002/jca.21671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Joseph H. Cho
- Department of Pathology; The University of Chicago; Chicago Illinois
| | - Megan Parilla
- Department of Pathology; The University of Chicago; Chicago Illinois
| | - Angela Treml
- BloodCenter of Wisconsin, Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Geoffrey D. Wool
- Department of Pathology; The University of Chicago; Chicago Illinois
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6
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Lee CL, Colombo PC, Eisenberger A, Diuguid D, Jennings DL, Han J, Salna MP, Takeda K, Kurlansky PA, Yuzefpolskaya M, Garan AR, Naka Y, Takayama H. Abciximab/Heparin Therapy for Left Ventricular Assist Device Implantation in Patients With Heparin-Induced Thrombocytopenia. Ann Thorac Surg 2018; 105:122-128. [DOI: 10.1016/j.athoracsur.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/21/2017] [Accepted: 06/07/2017] [Indexed: 12/13/2022]
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Salter BS, Weiner MM, Trinh MA, Heller J, Evans AS, Adams DH, Fischer GW. Heparin-Induced Thrombocytopenia: A Comprehensive Clinical Review. J Am Coll Cardiol 2017; 67:2519-32. [PMID: 27230048 DOI: 10.1016/j.jacc.2016.02.073] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 12/13/2022]
Abstract
Heparin-induced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to low-molecular weight heparin. In this comprehensive review, the authors highlight heparin-induced thrombocytopenia's risk factors, clinical presentation, pathophysiology, diagnostic principles, and treatment. The authors place special emphasis on the management of patients requiring procedures using cardiopulmonary bypass or interventions in the catheterization laboratory. Clinical vigilance of this disease process is important to ensure its recognition, diagnosis, and treatment. Misdiagnosis of the syndrome, as well as misunderstanding of the disease process, continues to contribute to its morbidity and mortality.
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Affiliation(s)
- Benjamin S Salter
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York.
| | - Menachem M Weiner
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York
| | - Muoi A Trinh
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York
| | - Joshua Heller
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York
| | - Adam S Evans
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York
| | - David H Adams
- Department of Cardiac Surgery, Mount Sinai Medical Center, New York, New York
| | - Gregory W Fischer
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York
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Bain J, Flannery AH, Flynn J, Dager W. Heparin induced thrombocytopenia with mechanical circulatory support devices: review of the literature and management considerations. J Thromb Thrombolysis 2017; 44:76-87. [DOI: 10.1007/s11239-017-1494-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Choxi AA, Patel PA, Augoustides JG, Benitez-Lopez J, Gutsche JT, Murad H, Rodriguez-Blanco YF, Fabbro M, Crookston KP, Gerstein NS. Bivalirudin for Cardiopulmonary Bypass in the Setting of Heparin-Induced Thrombocytopenia and Combined Heart and Kidney Transplantation—Diagnostic and Therapeutic Challenges. J Cardiothorac Vasc Anesth 2017; 31:354-364. [DOI: 10.1053/j.jvca.2016.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Indexed: 12/25/2022]
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Palatianos G, Michalis A, Alivizatos P, Lacoumenda S, Geroulanos S, Karabinis A, Iliopoulou E, Soufla G, Kanthou C, Khoury M, Sfyrakis P, Stavridis G, Astras G, Vassili M, Antzaka C, Marathias K, Kriaras I, Tasouli A, Papadopoulos K, Katafygioti M, Matoula N, Angelidis A, Melissari E. Perioperative use of iloprost in cardiac surgery patients diagnosed with heparin-induced thrombocytopenia-reactive antibodies or with true HIT (HIT-reactive antibodies plus thrombocytopenia): An 11-year experience. Am J Hematol 2015; 90:608-17. [PMID: 25808486 DOI: 10.1002/ajh.24017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 11/09/2022]
Abstract
Thrombocytopenia and thromboembolism(s) may develop in heparin immune-mediated thrombocytopenia (HIT) patients after reexposure to heparin. At the Onassis Cardiac Surgery Center, 530 out of 17,000 patients requiring heart surgery over an 11-year period underwent preoperative HIT assessment by ELISA and a three-point heparin-induced platelet aggregation assay (HIPAG). The screening identified 110 patients with HIT-reactive antibodies, out of which 46 were also thrombocytopenic (true HIT). Cardiac surgery was performed in HIT-positive patients under heparin anticoagulation and iloprost infusion. A control group of 118 HIT-negative patients received heparin but no iloprost during surgery. For the first 20 patients, the dose of iloprost diminishing the HIPAG test to ≤5% was determined prior to surgery by in vitro titration using the patients' own plasma and donor platelets. In parallel, the iloprost "target dose" was also established for each patient intraoperatively, but before heparin administration. Iloprost was infused initially at 3 ng/kg/mL and further adjusted intraoperatively, until ex vivo aggregation reached ≤5%. As a close correlation was observed between the "target dose" identified before surgery and that established intraoperatively, the remaining 90 patients were administered iloprost starting at the presurgery identified "target dose." This process significantly reduced the number of intraoperative HIPAG reassessments needed to determine the iloprost target dose, and reduced surgical time, while maintaining similar primary clinical outcomes to controls. Therefore, infusion of iloprost throughout surgery, under continuous titration, allows cardiac surgery to be undertaken safely using heparin, while avoiding life-threatening iloprost-induced hypotension in patients diagnosed with HIT-reactive antibodies or true HIT.
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Affiliation(s)
- George Palatianos
- 3rd Department of Cardiothoracic Surgery; Onassis Cardiac Surgery Center; Athens Greece
| | - Alkiviadis Michalis
- 2nd Department of Cardiothoracic Surgery; Onassis Cardiac Surgery Center; Athens Greece
| | - Petros Alivizatos
- 1st Department of Cardiothoracic Surgery; Onassis Cardiac Surgery Center; Athens Greece
| | | | | | | | - Eugenia Iliopoulou
- Department of Haematology/Blood Transfusion; Onassis Cardiac Surgery Center; Athens Greece
| | - Giannoula Soufla
- Department of Haematology/Blood Transfusion; Onassis Cardiac Surgery Center; Athens Greece
| | - Chryso Kanthou
- Department of Oncology, School of Medicine; University of Sheffield; Sheffield United Kingdom
| | - Mazen Khoury
- 2nd Department of Cardiothoracic Surgery; Onassis Cardiac Surgery Center; Athens Greece
| | - Petros Sfyrakis
- 1st Department of Cardiothoracic Surgery; Onassis Cardiac Surgery Center; Athens Greece
| | - George Stavridis
- 1st Department of Cardiothoracic Surgery; Onassis Cardiac Surgery Center; Athens Greece
| | - George Astras
- 3rd Department of Cardiothoracic Surgery; Onassis Cardiac Surgery Center; Athens Greece
| | - Maria Vassili
- Department of Anaesthesiology; Onassis Cardiac Surgery Center; Athens Greece
| | - Christina Antzaka
- Department of Anaesthesiology; Onassis Cardiac Surgery Center; Athens Greece
| | | | - Ioannis Kriaras
- Intensive Care Unit, Onassis Cardiac Surgery Center; Athens Greece
| | | | | | - Marina Katafygioti
- Department of Haematology/Blood Transfusion; Onassis Cardiac Surgery Center; Athens Greece
| | - Nikoletta Matoula
- Department of Haematology/Blood Transfusion; Onassis Cardiac Surgery Center; Athens Greece
| | - Antonios Angelidis
- Department of Haematology/Blood Transfusion; Onassis Cardiac Surgery Center; Athens Greece
| | - Euthemia Melissari
- Department of Haematology/Blood Transfusion; Onassis Cardiac Surgery Center; Athens Greece
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McNair E, Marcoux JA, Bally C, Gamble J, Thomson D. Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery. Perfusion 2015; 31:189-99. [PMID: 25934498 DOI: 10.1177/0267659115583525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- E McNair
- 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
| | - J-A Marcoux
- Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
| | - C Bally
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Gamble
- Department of Anesthesiology and Pain Management, College of Medicine and Saskatoon Health Region, Saskatoon, SK, Canada
| | - D Thomson
- Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
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12
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Les différentes alternatives d’anticoagulation au couple héparine/protamine en chirurgie cardiaque sous circulation extra-corporelle. Can J Anaesth 2015; 62:518-28. [DOI: 10.1007/s12630-015-0339-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/06/2015] [Indexed: 10/24/2022] Open
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Nhieu S, Nguyen L, Pretorius V, Ovando J, Moore D, Banks D, Koster A, Morshuis M, Faraoni D. CASE 1–2015. J Cardiothorac Vasc Anesth 2015; 29:210-20. [DOI: 10.1053/j.jvca.2014.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Indexed: 01/29/2023]
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Pappalardo F, Agracheva N, Covello RD, Pieri M, De Bonis M, Calabrò MG, Koster A, Zangrillo A. Anticoagulation for Critically Ill Cardiac Surgery Patients: Is Primary Bivalirudin the Next Step? J Cardiothorac Vasc Anesth 2014; 28:1013-17. [DOI: 10.1053/j.jvca.2013.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Indexed: 11/11/2022]
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Pieri M, Agracheva N, Di Prima AL, Nisi T, De Bonis M, Isella F, Zangrillo A, Pappalardo F. Primary Anticoagulation With Bivalirudin for Patients With Implantable Ventricular Assist Devices. Artif Organs 2013; 38:342-6. [DOI: 10.1111/aor.12168] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marina Pieri
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - Natalia Agracheva
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - Ambra Licia Di Prima
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - Teodora Nisi
- Department of Cardiac Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Michele De Bonis
- Department of Cardiac Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Francesca Isella
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Milan Italy
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Chai D, Wang R, Bai N, Cai Y, Liang B. Development and validation of a highly sensitive LC-MS/MS method for quantitation of bivalirudin in human plasma: application to a human pharmacokinetic study. Biomed Chromatogr 2013; 27:1788-93. [PMID: 23893840 DOI: 10.1002/bmc.2998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Dong Chai
- Pharmaceutical Care Center; Chinese PLA General Hospital; Beijing 100853 China
- Department of Pharmacy; Hainan Branch of PLA General Hospital; Sanya 572013 Hainan Province China
| | - Rui Wang
- Department of Drug Clinical Trial; PLA General Hospital; Beijing 100853 China
| | - Nan Bai
- Department of Drug Clinical Trial; PLA General Hospital; Beijing 100853 China
| | - Yun Cai
- Pharmaceutical Care Center; Chinese PLA General Hospital; Beijing 100853 China
| | - Beibei Liang
- Department of Drug Clinical Trial; PLA General Hospital; Beijing 100853 China
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Zhang R, Huang Y, Zhang M, Liu J. Bivalirudin utilization in rats undergoing cardiopulmonary bypass: preventing the increase of antiheparin/platelet factor 4 antibody in perioperative period. Clin Appl Thromb Hemost 2012; 20:196-8. [PMID: 22914811 DOI: 10.1177/1076029612456735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the impact of bivalirudin alternative treatment on antiheparin/platelet factor 4 antibody levels perioperatively in rats undergoing cardiopulmonary bypass (CPB). METHODS Two groups of rats received heparin pretreatment and two groups of rats not, and during CPB all the four groups received either bivalirudin or heparin. Pre-CPB and post-CPB day 7 venous blood samples were used to determine the levels of antiheparin/PF4 antibody immunoglobulin (Ig) G with enzyme-linked immunosorbent assay. RESULTS Preoperative heparin pretreatment increased the antiheparin/PF4 antibody IgG levels (P < .01), while the administration of heparin further increased this levels (P < .01). The use of bivalirudin prevented further increase in antiheparin/PF4 antibody IgG levels. CONCLUSION Bivalirudin, as a direct thrombin inhibitor, could circumvent the increased antiheparin/PF4 antibody level in circulation due to the heparin administration.
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Affiliation(s)
- Ruidong Zhang
- 1Department of Anesthesiology, Shanghai Children's Medical, Center School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Zhang D, Wang Z, Zhao X, Lu W, Gu J, Cui Y. Pharmacokinetics, Pharmacodynamics, Tolerability and Safety of Single Doses of Bivalirudin in Healthy Chinese Subjects. Biol Pharm Bull 2011; 34:1841-8. [DOI: 10.1248/bpb.34.1841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Dongmei Zhang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital
| | - Zining Wang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital
| | - Xia Zhao
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital
| | - Wei Lu
- The State Key Laboratory of Natural and Biomimetic Drugs, Peking University
| | - Jingkai Gu
- Research Center for Drug Metabolism, Jilin University
| | - Yimin Cui
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital
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