Bivalirudin anticoagulation for cardiopulmonary bypass during cardiac surgery
Scoping review published in Perfusion (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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Scoping review of bivalirudin CPB (2 RCTs, 1 retrospective, 3 pilot studies, 30 case reports 2010-2023) with bivalirudin showing 0-3% mortality versus 0-9% for heparin and 0-6% major bleeding versus 0-27%.
Por qué esto importa para la hirudoterapia
Esta revisión de alcance (scoping review) explora el uso de bivalirudina como anticoagulante alternativo para la cirugía con derivación cardiopulmonar, motivada por una incidencia aproximada del 2% de trombocitopenia inducida por heparina y una tasa del 4–26% de resistencia a la heparina en pacientes de cirugía cardíaca. A partir de dos ensayos controlados aleatorizados, una comparación retrospectiva, tres estudios piloto y 30 reportes de caso, los autores concluyen que la bivalirudina parece proporcionar una seguridad y efectividad similares a las de la heparina para la derivación cardiopulmonar en diversos procedimientos cardíacos. El resumen no menciona hirudina, sanguijuelas ni ningún compuesto derivado de sanguijuela, por lo que no puede establecerse un vínculo defendible con la hirudoterapia. Se trata de un artículo de revisión sin datos originales, no involucra sanguijuelas ni hirudoterapia, y los autores señalan que los datos comparativos siguen siendo limitados y solicitan más investigación.
Citación
Bivalirudin anticoagulation for cardiopulmonary bypass during cardiac surgery.
Meshulami N et al. · Perfusion, 2023
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026