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Special Considerations Cell saver use is recommended and CPD can be used as an anticoagulant. What amounts of bivalirudin the process of cell saving removes are unclear at this time as there is no data. As mentioned earlier hemoconcentration will remove circulating bivalirudin. Anticoagulation protocols must be monitored more closely and rebolusing used if the act levels fall below the 2.5 baseline threshold. At the present time it is unclear what impact, if any, the numerous coatings that are available have on a routine patient receiving bivalirudin. It is important to avoid heparin coated circuits and heparin coated catheters on a patient with HIT/TS. In an emergent conversion to CPB from OPCAB we recommend rebolusing the patient with a 0.5mg/kg dose followed by a 2.5mg/kg/hr infusion. Also 50 mg should be added to the cardiopulmonary bypass circuit. ACT values of 2.5 times baseline should be expected.
Summary or In my opinion…… Safe anticoagulant for CPB Need to look at ACT in a new light Avoid stasis in circuit Calls for increased communication among surgeon, anesthesiologist, i and perfusionist i
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 34 and 35: Anticoagulation Monitoring A kaolin
Page 36 and 37: Use of Bivalirudin During CPB Cardi
Page 40 and 41: Once again…. This is not heparin
Page 42: One final question Does anyone reco

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