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Anticoagulation Monitoring A kaolin based act system is used in our hospital After loading dose is given to the patient expect an increased ACT of 2.5 times baseline A continuous infusion of 2.5 mg/kg/hr maintains the ACT at this target throughout bypass run Monitor the ACT every thirty minutes unless the patient is being hemoconcentrated If hemoconcentrating the patient then monitor the ACT every 15 minutes as the hemoconcentrator does remove bivalirudin If the ACT should fall below the 2.5 threshold the patient can be rebolused with a dose of 0.2 to 0.5 of the initial loading dose. Adjusting the drip will not raise the drug level in a timely manner
Use of Bivalirudin During CPB No need to redesign circuit Normal <strong>com</strong>ponents are set up in the standard fashion The overriding concern is the elimination of areas of blood stasis throughout the circuit Either an open system or a closed system may be used Retrograde autologous priming may be used as long as initiation of bypass is within minutes Keep level in venous reservoir around 1000 to 1200 mls. Put any excess volume in CPD bags for later use Put clamp high on bypass loop around arterial filter to diminish stagnant blood in tubing Put floppysucker in left chest to remove stagnant blood
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 18 and 19: Hirudin / Lepirudin / Bivalrudin Cl
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 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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