American Society of Hirudotherapy

Bivalirudin for Pediatric Procedural Anticoagulation: A Narrative Review

Narrative review published in Anesth Analg (2019)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentClinical TrialsZaleski 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

Narrative review consolidating pediatric procedural bivalirudin recommendations, primarily for treatment of HIT thrombosis, with pediatric pharmacokinetics/pharmacodynamics extrapolated from adult data.

Why This Matters for Hirudotherapy

This narrative review synthesizes the published literature on bivalirudin—a direct thrombin inhibitor—for procedural anticoagulation in the pediatric population, most commonly for thrombosis secondary to heparin-induced thrombocytopenia. The authors note that much of the pediatric pharmacokinetic and pharmacodynamic understanding is extrapolated from adult data, owing to the rarity of HIT in children and the absence of FDA-approved indications in this age group. The abstract does not mention hirudin, leeches, or any leech-derived compound, so no defensible hirudotherapy link can be drawn from this article. This is a review article without original data, does not involve leeches or hirudotherapy, and provides practice recommendations rather than new clinical findings.

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

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