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Hirudin / Lepirudin / Bivalrudin Class of anticoagulants derived from leech spit Hirudin is the naturally occurring molecule 65 amino acid peptide Lepirudin is a re<strong>com</strong>binant hirudin structurally almost identical to natural peptide Bivalirudin is a synthetic analog 20 amino acid peptide 1 65
Mechanism of Action Blocks clotting activity of thrombin Binds 1:1 to thrombin (clot-bound and free) Independent of antithrombin III Not inhibited by Platelet Factor 4 (PF4) No cross reaction with HIT antibodies
Page 1: An Alternative Anticoagulant Craig
Page 4 and 5: McLean Discovered heparin to reduce
Page 6 and 7: Heparin and Protamine -- Perfect Pa
Page 8 and 9: Historical Perspective - 1960s and
Page 10 and 11: New Challenges PTCA Stents Drug Ste
Page 12 and 13: Thrombosis in HIT High risk for ven
Page 14 and 15: Definition iti of Classic HIT 1.Thr
Page 16 and 17: Ancrod Malaysain Pit Viper
Page 20 and 21: Bivalurudin Direct Thrombin Inhibit
Page 22 and 23: Bivalirudin in CPB Off - label use
Page 24 and 25: Differences and Concerns Bolus and
Page 26 and 27: Anticoagulation ACT 2.5 X Baseline
Page 28 and 29: Circuit Non coated circuit Add A-V
Page 30 and 31: Hemoconcentration ACT bolus of 0.3m
Page 32 and 33: Cell Saver Citrate as anticoagulant
Page 34 and 35: Anticoagulation Monitoring A kaolin
Page 36 and 37: Use of Bivalirudin During CPB Cardi
Page 38 and 39: Special Considerations Cell saver u
Page 40 and 41: Once again…. This is not heparin
Page 42: One final question Does anyone reco

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