Bivalirudin Anticoagulation for a Pediatric Patient with Heparin-Induced Thrombocytopenia and Thrombosis Requiring Cardiopulmonary Bypass for Ventricular Assist Device Placement
Case report published in J Extra Corpor Technol (2016)
Abstract
The direct thrombin inhibitor bivalirudin is an option for anticoagulation in patients with heparin induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB). There are a limited number of reports of pediatric patients in which bivalirudin has been used for anticoagulation for CPB. We present the case of an 11 year old male with acute onset heart failure secondary to idiopathic dilated cardiomyopathy that developed heparin induced thrombocytopenia with thrombosis (HITT). The patient was anticoagulated in the operating room with bivalirudin and placed on CPB for insertion of a HeartWare(®) Ventricular Assist Device (Heartware(®)). Modified techniques were utilized. This included use of the Terumo CDI 500 (Terumo Cardiovascular Systems, Inc.) in-line blood gas monitor which contains a heparin coated arterial shunt sensor. We flushed this sensor with buffered saline preoperatively and noted no significant decrease in platelet count postoperatively. The patient was successfully placed on the ventricular assist device and was subsequently listed for heart transplantation.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
11-year-old male with idiopathic dilated cardiomyopathy and HITT successfully anticoagulated with bivalirudin during CPB for HeartWare VAD insertion using modified technique with buffered saline flush.
Por qué esto importa para la hirudoterapia
Este caso clínico describe a un niño de 11 años con miocardiopatía dilatada idiopática que desarrolló trombocitopenia inducida por heparina con trombosis (TIH) y fue anticoagulado con bivalirudina durante la circulación extracorpórea para la implantación de un VAD HeartWare. El resumen señala modificaciones técnicas, incluido el lavado con solución salina tamponada de un sensor arterial recubierto de heparina, sin una caída plaquetaria posoperatoria significativa, y una colocación exitosa del dispositivo con posterior inclusión en lista de trasplante. No existe una conexión defendible con la hirudoterapia, la terapia con sanguijuelas o el secretoma de la sanguijuela a partir de este resumen, que identifica la bivalirudina únicamente como un inhibidor directo de la trombina sin ninguna mención a la hirudina, las sanguijuelas o su derivación de ellas. Al tratarse de un caso único, los hallazgos no son generalizables, y el resumen señala el número limitado de publicaciones pediátricas en este ámbito.
Citación
Bivalirudin Anticoagulation for a Pediatric Patient with Heparin-Induced Thrombocytopenia and Thrombosis Requiring Cardiopulmonary Bypass for Ventricular Assist Device Placement.
Faella KH et al. · The journal of extra-corporeal technology, 2016
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026