Bivalirudin as a substitute for heparin in neurointervention for patients with heparin-induced thrombocytopenia
Research article published in Journal of stroke and cerebrovascular diseases (2024)
Abstract
OBJECTIVES: Heparin-induced thrombocytopenia is a known complication of heparin exposure with potentially life-threatening sequelae. Direct thrombin inhibitors can be substituted for heparin in patients with heparin-induced thrombocytopenia that require anticoagulation. However, the use of direct thrombin inhibitors as a substitute for heparin has not been widely reported in the neuroendovascular literature. MATERIALS AND METHODS: Here we report the first use of the direct thrombin inhibitor bivalirudin in a neuroendovascular procedure as a substitute for heparin in a patient with a ruptured pseudoaneurysm and heparin-induced thrombocytopenia, and review the literature on the use of bivalirudin and argatroban for such patients. RESULTS: Bivalirudin was safely and effectively used in the case reported, with no thrombotic or hemorrhagic complications. Our literature review revealed a paucity of studies on the use of heparin alternatives, including bivalirudin, in neuroendovascular procedures in patients with heparin-induced thrombocytopenia. CONCLUSIONS: Heparin-induced thrombocytopenia is an important iatrogenic disease process in patients undergoing neuroendovascular procedures, and developing protocols to diagnose and manage heparin-induced thrombocytopenia is important for healthcare systems. While further research needs to be done to establish the full range of anticoagulation options to substitute for heparin, our case indicates bivalirudin as a potential candidate.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Bivalirudin as a substitute for heparin in neurointervention for patients with heparin-induced thrombocytopenia.
Por qué esto importa para la hirudoterapia
This article presents a case of bivalirudin use as a heparin substitute during neuroendovascular treatment of a ruptured pseudoaneurysm in a patient with heparin-induced thrombocytopenia, accompanied by a literature review of direct thrombin inhibitors (bivalirudin and argatroban) in neuroendovascular settings. The reported case had no thrombotic or hemorrhagic complications, and the authors note a paucity of evidence in this niche. For ASH, no defensible leech or hirudotherapy connection exists from the abstract: it does not mention leeches, hirudin, or leech-derived therapy. Honest caveat: this is largely a single case report plus review, involves no actual leeches or hirudotherapy, and makes no efficacy claims beyond the described case.
Citación
Bivalirudin as a substitute for heparin in neurointervention for patients with heparin-induced thrombocytopenia
Sukumaran M et al. · Journal of stroke and cerebrovascular diseases, 2024
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026