Bivalirudin for cardiopulmonary bypass in a patient with heparin allergy
Case report published in J Cardiothorac Surg (2023)
Abstract
BACKGROUND: Hypersensitivity reactions to heparin are uncommon conditions but pose a serious clinical problem for patients requiring cardiopulmonary bypass. Bivalirudin is a reversible direct thrombin inhibitor that can be used instead of heparin. CASE REPORT: A 49-year-old male patient was admitted to our hospital for coronary artery bypass graft operation with mitral insufficiency and tricuspid valve insufficiency. Heparin allergy was confirmed by skin biopsy and skin tests. Due to this allergy, we used bivalirudin (Bivacard VEM drug, Turkey) during the surgery. A loading dose of 1.0 mg/kg (100 mg) bivalirudin was administered through the central line and a continuous infusion of 2.5 mg/kg/h of the anticoagulant was initiated following the approved protocol. Serial ACTs were obtained at 15-minute intervals during the procedure and the measurements were 330s, 320s, 350s, 360s, and 340s consecutively. Additional boluses of 0.5 mg/kg (50 mg) were administered for each measurement. Left anterior descending, obtuse marginal arteries and the right coronary artery were grafted with the left internal mammary and saphenous veins. Also, mitral valve replacement with St Jude mechanical heart valve and tricuspid ring annuloplasty was performed with Medtronic Duran ring. After the surgery, the patient had an uneventful period in the postoperative intensive care unit with a total of 600ml and 300ml chest tube drainage for two days and was discharged on the 7th day. CONCLUSION: Alternative anticoagulation strategies are needed for cardiopulmonary bypass in patients unable to use heparin. Bivalirudin may be recommended as a viable alternative anticoagulant in patients with heparin allergy during cardiopulmonary bypass. However, each patient should be evaluated individually and it should not be forgotten that more than recommended doses may be needed.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Hypersensitivity reactions to heparin are uncommon conditions but pose a serious clinical problem for patients requiring cardiopulmonary bypass.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe el uso de bivalirudina —caracterizada en el resumen como un inhibidor directo reversible de la trombina— como alternativa a la heparina para la anticoagulación durante la circulación extracorpórea en un varón de 49 años con alergia a la heparina confirmada mediante biopsia cutánea y pruebas cutáneas. Se administró una dosis de carga de 1.0 mg/kg seguida de una infusión continua de 2.5 mg/kg/h, con monitorización seriada del tiempo de coagulación activado a intervalos de 15 minutos y bolos adicionales; el paciente se recuperó sin incidentes y fue dado de alta al séptimo día postoperatorio. El resumen no menciona sanguijuelas, hirudina ni hirudoterapia, y no aporta información que conecte la bivalirudina con el secretoma de la sanguijuela ni con ningún compuesto derivado de sanguijuela. Advertencia: Se trata de un reporte de caso aislado que involucra un anticoagulante farmacéutico; basándose únicamente en el resumen, no tiene relevancia directa con la hirudoterapia ni con el dominio de ASH.
Citación
Bivalirudin for cardiopulmonary bypass in a patient with heparin allergy.
Boysan E et al. · J Cardiothorac Surg, 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