Role of Bivalirudin for Anticoagulation in Adult Perioperative Cardiothoracic Practice.

Erdös, Gabor; Ortmann, Erik; Martinez Lopez De Arroyabe, Blanca; Reid, Catherine; Koster, Andreas (2019). Role of Bivalirudin for Anticoagulation in Adult Perioperative Cardiothoracic Practice. (In Press). Journal of cardiothoracic and vascular anesthesia Elsevier 10.1053/j.jvca.2019.08.022

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Bivalirudin, a direct thrombin inhibitor with a fast onset of action and short half-life, is often referred to as an alternative anticoagulant to a heparin/protamine regimen. Bivalirudin demonstrated promising results as an anticoagulant in cardiac surgery with and without cardiopulmonary bypass, postcardiotomy extracorporeal membrane oxygenation, interventional cardiology and endovascular procedures, and particularly in the treatment of patients with heparin-induced thrombocytopenia undergoing high-risk cardiac surgery. Currently, bivalirudin in cardiac surgery with cardiopulmonary bypass has a limited clinical spectrum, likely because the still obvious advantages of its competitor, heparin, outweigh it in terms of medical costs, established point-of-care monitoring systems, and availability of protamine as a reversal agent. The unique pharmacology of the drug also requires adjustment of surgical and perfusion strategy. In contrast, in off-pump coronary artery surgery, established protocols from interventional cardiology can be easily translated into the operating room. In this setting bivalirudin has the potential for a more important role in the future. Through a triple mechanism of action-inhibition of plasma thrombin, clot bound thrombin, and collagen-induced platelet activation-bivalirudin may perform better than heparin by attenuating the immediate postoperative prothrombotic state and thus positively impacting the early coronary graft patency after off-pump coronary artery bypass grafting. Further studies are necessary to better evaluate this niche field and discover further applications for this unique anticoagulant.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Erdös, Gabor and Reid, Catherine

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1053-0770

Publisher:

Elsevier

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

08 Oct 2019 15:35

Last Modified:

23 Oct 2019 21:56

Publisher DOI:

10.1053/j.jvca.2019.08.022

PubMed ID:

31521492

Uncontrolled Keywords:

bivalirudin cardiac surgery cardiopulmonary bypass extracorporeal membrane oxygenation and left ventricular assist device heparin-induced thrombocytopenia interventional cardiology procedures off-pump coronary artery bypass grafting

BORIS DOI:

10.7892/boris.133784

URI:

https://boris.unibe.ch/id/eprint/133784

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