American Society of Hirudotherapy

Bivalirudin as an anticoagulation strategy for acute hemodialysis in children: Two cases with a summary of recent literature

Research article published in Hemodialysis international (2024)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportDrug DevelopmentViaene LV et al. · Hemodialysis international, 2024

Abstract

Unfractionated heparin is the most used anticoagulative agent for extracorporeal settings in children, including acute hemodialysis modalities. In certain situations, such as heparin-induced thrombocytopenia, alternatives must be applied. The direct thrombin inhibitor bivalirudin has come forth as an attractive substitute. Bivalirudin is currently only approved for adult use in specific percutaneous coronary intervention settings. However, it has a growing off-label popularity in different contexts for both adult and pediatric patients. Experience with bivalirudin in children is mainly limited to extracorporeal membrane oxygenation, ventricular assist devices and during cardiopulmonary bypass surgery. Literature about its use as anticoagulation strategy for pediatric hemodialysis is very scarce. Here, we present two pediatric cases where bivalirudin was used during acute hemodialysis, followed by a short summary of recent literature.

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

Publication typeJournal ArticleCase ReportsReview
Indexed MeSH termsHumansHirudinsRecombinant ProteinsRenal DialysisPeptide FragmentsAnticoagulantsMaleFemaleChildAdolescentChild, PreschoolAntithrombins

Summary

Bivalirudin as an anticoagulation strategy for acute hemodialysis in children: Two cases with a summary of recent literature.

Why This Matters for Hirudotherapy

This paper presents two pediatric case reports using bivalirudin, described in the abstract as a direct thrombin inhibitor, as an alternative anticoagulant for acute hemodialysis when unfractionated heparin is contraindicated, such as in heparin-induced thrombocytopenia, accompanied by a summary of recent literature. The abstract makes no mention of hirudin, leeches, or any relationship to hirudotherapy. Therefore, no defensible leech or ASH connection can be drawn from this abstract alone. The clinical data is limited to two cases plus a brief literature summary, serving as an anecdotal report of off-label usage rather than robust safety or efficacy evidence.

Citation

Bivalirudin as an anticoagulation strategy for acute hemodialysis in children: Two cases with a summary of recent literature

Viaene LV et al. · Hemodialysis international, 2024

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.