Bivalirudin use in an infant with persistent clotting on unfractionated heparin
Case report published in Journal of Pediatric Pharmacology and Therapeutics (2011)
Abstract
Bivalirudin is a direct thrombin inhibitor approved for use in adult patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention. Recently, its use in the pediatric population has increased due to its anti-thrombin-independent mechanism of action. As heparin products produce great inter- and intraindividual variability in pediatric patients, often due to decreased anti-thrombin concentrations in the first year of life, some practitioners have turned to direct thrombin inhibitors, such as bivalirudin, for more predictable pharmacokinetics and effects on bound and circulating thrombin. We report our experience using bivalirudin in a 2-month-old female with recurrent systemic thrombi despite continuous unfractionated heparin infusion. Due to the patient's inability to maintain therapeutic activated partial thromboplastin time (aPTT) values during heparin infusion, bivalirudin was initiated at 0.1 mg/kg/h and increased due to subtherapeutic aPTTs to a maximum of 0.58 mg/kg/h. Therapeutic aPTTs were achieved at the increased dose; however, the patient's worsening renal impairment with resultant drug accumulation and overwhelming sepsis on day 5 of therapy led to discontinuation of the infusion and the initiation of comfort measures.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Two-month-old female with recurrent systemic thrombi unresponsive to unfractionated heparin; bivalirudin was titrated from 0.1 to 0.58 mg/kg/h and achieved therapeutic aPTTs before being discontinued due to renal impairment and sepsis.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe el uso de bivalirudina en una lactante de sexo femenino de 2 meses con trombos sistémicos recurrentes a pesar de la infusión continua de heparina no fraccionada. Se informa que se lograron aPTT terapéuticos tras el escalamiento de la dosis, pero el empeoramiento de la insuficiencia renal con acumulación del fármaco y una sepsis abrumadora condujeron a la interrupción del fármaco y al inicio de medidas de confort en el día 5. El resumen no menciona sanguijuelas, hirudina, saliva de sanguijuela ni hirudoterapia, por lo que no aporta ninguna conexión defendible con el dominio de la ASH ni con el secretoma de la sanguijuela. Sus limitaciones son las propias de un reporte de caso: una sola lactante en estado crítico, sin terapia con sanguijuelas, y sin inferencias sobre los resultados de la hirudoterapia.
Citación
Bivalirudin use in an infant with persistent clotting on unfractionated heparin.
Malloy KM et al. · Journal of Pediatric Pharmacology and Therapeutics, 2011
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026