Intraoperative Bivalirudin Use in Patient Undergoing Femoral Endarterectomy with Heparin-Induced Thrombocytopenia: Case Report and Review of the Literature
Case report published in Vasc Endovascular Surg (2023)
Abstract
PURPOSE: To describe the intraoperative use of bivalirudin during lower extremity revascularization in the setting of heparin-induced thrombocytopenia (HIT). CASE SUMMARY: A 65 year-old man presented with left common iliac, external iliac, and femoral artery occlusion necessitating revascularization with left femoral endarterectomy and common and external iliac stent angioplasty. Three months before the femoral endarterectomy, the patient was hospitalized for a coronary artery bypass procedure. During this admission, the patient tested positive for the presence of heparin-PF4 antibody complexes. With the patient's recent history of HIT, bivalirudin was selected as the optimal agent for intraoperative anticoagulation. Bivalirudin was administered as a 50 mg bolus, followed by a continuous infusion initiated at 1.75 mg/kg/hr. Repeated bivalirudin boluses were necessary to maintain an activated clotting time (ACT) necessary for the revascularization procedures and recurrent subacute thrombi despite appropriate ACT values. DISCUSSION: Bivalirudin has been utilized for cardiopulmonary bypass and carotid endarterectomy (CEA), but data for dosing in lower extremity revascularization are lacking. As the risk for thrombosis with HIT continues for months after diagnosis, it is important to elucidate optimal dosing of non-heparin anticoagulant options, such as the direct thrombin inhibitor, bivalirudin. The absence of validated dosing strategies for bivalirudin can result in prolonged operative times, increased risk of bleeding, and inadequate anticoagulation. CONCLUSION: Bivalirudin is an appropriate agent for intraoperative anticoagulation in lower extremity revascularization. However, further investigation into the optimal intraoperative bivalirudin dosing regimen is necessary.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
To describe the intraoperative use of bivalirudin during lower extremity revascularization in the setting of heparin-induced thrombocytopenia (HIT).
Por qué esto importa para la hirudoterapia
Este caso clínico describe el uso intraoperatorio de bivalirudina — un inhibidor directo de la trombina — para la anticoagulación durante endarterectomía femoral y angioplastia con stent de las arterias ilíacas común y externa en un hombre de 65 años con antecedente reciente de trombocitopenia inducida por heparina. La bivalirudina se administró como un bolo de 50 mg seguido de una infusión de 1,75 mg/kg/h, con bolos repetidos necesarios para mantener un tiempo de coagulación activado adecuado, y los autores señalan que faltan datos de dosificación validados para la revascularización de las extremidades inferiores. El resumen no menciona sanguijuelas, hirudina ni hirudoterapia, y no proporciona ninguna base para conectar la bivalirudina con el secretoma de la sanguijuela o con un compuesto derivado de la sanguijuela. Caveat: se trata de un caso clínico único de un anticoagulante farmacéutico; según el resumen, no tiene relevancia directa para la hirudoterapia ni para el ámbito de ASH.
Citación
Intraoperative Bivalirudin Use in Patient Undergoing Femoral Endarterectomy with Heparin-Induced Thrombocytopenia: Case Report and Review of the Literature.
Haffler ZJ et al. · Vasc Endovascular Surg, 2023
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026