American Society of Hirudotherapy

Bivalirudin for pediatric procedural anticoagulation: a narrative review

Narrative review published in Anesthesia and Analgesia (2019)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical TrialsDrug DevelopmentZaleski KL et al. · Anesthesia and analgesia, 2019

Abstract

Bivalirudin (Angiomax; The Medicines Company, Parsippany, NJ), a direct thrombin inhibitor, has found increasing utilization as a heparin alternative in the pediatric population, most commonly for the treatment of thrombosis secondary to heparin-induced thrombocytopenia. Due to the relative rarity of heparin-induced thrombocytopenia as well as the lack of Food and Drug Administration-approved indications in this age group, much of what is known regarding the pharmacokinetics and pharmacodynamics of bivalirudin in this population has been extrapolated from adult data. This narrative review will present recommendations regarding the use of bivalirudin for procedural anticoagulation in the pediatric population based on the published literature.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsAdolescentAge FactorsAntithrombinsBlood CoagulationCardiac CatheterizationCardiac Surgical ProceduresCardiopulmonary BypassChildChild, PreschoolDrug Administration ScheduleDrug Dosage CalculationsHemorrhage

Summary

Comprehensive review of bivalirudin pharmacology, dosing strategies, and procedural use in pediatric cardiac catheterization and cardiopulmonary bypass — emphasizing HIT and heparin-resistance contexts.

Why This Matters for Hirudotherapy

This narrative review examines the use of bivalirudin—a direct thrombin inhibitor—for procedural anticoagulation in the pediatric population, most commonly for thrombosis secondary to heparin-induced thrombocytopenia, and provides practice recommendations based on the published literature. The authors note that much of the pharmacokinetic and pharmacodynamic understanding of bivalirudin in children has been extrapolated from adult data, given the rarity of HIT and the absence of FDA-approved pediatric indications. For ASH's domain, this review has no defensible connection to hirudotherapy or the leech secretome—the abstract describes bivalirudin as a direct thrombin inhibitor used as a heparin alternative without any mention of leeches, hirudin, or molecular derivation from leech-derived compounds.

Citation

Bivalirudin for pediatric procedural anticoagulation: a narrative review.

Zaleski KL et al. · Anesthesia and analgesia, 2019

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.