Role of bivalirudin for anticoagulation in adult perioperative cardiothoracic practice
Cardiothoracic anesthesia review published in Journal of Cardiothoracic and Vascular Anesthesia (2019)
Abstract
Bivalirudin, a direct thrombin inhibitor with a fast onset of action and short half-life, is often referred to as an alternative anticoagulant to a heparin/protamine regimen. Bivalirudin demonstrated promising results as an anticoagulant in cardiac surgery with and without cardiopulmonary bypass, postcardiotomy extracorporeal membrane oxygenation, interventional cardiology and endovascular procedures, and particularly in the treatment of patients with heparin-induced thrombocytopenia undergoing high-risk cardiac surgery. Currently, bivalirudin in cardiac surgery with cardiopulmonary bypass has a limited clinical spectrum, likely because the still obvious advantages of its competitor, heparin, outweigh it in terms of medical costs, established point-of-care monitoring systems, and availability of protamine as a reversal agent. The unique pharmacology of the drug also requires adjustment of surgical and perfusion strategy. In contrast, in off-pump coronary artery surgery, established protocols from interventional cardiology can be easily translated into the operating room. In this setting bivalirudin has the potential for a more important role in the future. Through a triple mechanism of action-inhibition of plasma thrombin, clot bound thrombin, and collagen-induced platelet activation-bivalirudin may perform better than heparin by attenuating the immediate postoperative prothrombotic state and thus positively impacting the early coronary graft patency after off-pump coronary artery bypass grafting. Further studies are necessary to better evaluate this niche field and discover further applications for this unique anticoagulant.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Comprehensive review of bivalirudin use in adult cardiothoracic surgery — covers HIT, heparin alternatives, CPB anticoagulation, and ECMO maintenance.
Por qué esto importa para la hirudoterapia
Esta revisión examina la bivalirudina, un inhibidor directo de la trombina con un inicio de acción rápido y una semivida corta, como anticoagulante alternativo a la heparina/protamina en la práctica perioperatoria cardiotorácica en adultos, incluyendo cirugía cardíaca con y sin circulación extracorpórea, ECMO postcardiotomía, cardiología intervencionista y trombocitopenia inducida por heparina. El resumen discute el mecanismo de acción triple de la bivalirudina—inhibición de la trombina plasmática, de la trombina unida al coágulo y de la activación plaquetaria inducida por colágeno—así como sus ventajas potenciales en la cirugía coronaria sin bomba. Para el dominio de la ASH, la relevancia es, en el mejor de los casos, indirecta: el propio resumen no menciona las sanguijuelas, el origen natural de la hirudina ni la hirudoterapia, por lo que no se puede respaldar ninguna conexión con las sanguijuelas a partir del texto. El artículo no aporta datos primarios nuevos y se centra en las aplicaciones quirúrgicas de un agente farmacéutico.
Citación
Role of bivalirudin for anticoagulation in adult perioperative cardiothoracic practice.
Erdoes G et al. · Journal of cardiothoracic and vascular anesthesia, 2019
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026