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Antidote of heparin12/6/2023 We report a case of coronary artery bypass surgery, mitral valve replacement and tricuspid ring annuloplasty using bivalirudin for anticoagulation during CPB in a patient with hypersensitivity to heparin. These pharmacological properties enable its effective use during CPB. ![]() Bivalirudin level has been shown to correspond to activated clotting time (ACT). The minority of bivalirudin is cleared by the renal system. It has a half-life of 25 min in the presence of normal renal function and is mostly cleared from the circulation by proteolytic enzymes. An alternative anticoagulant to heparin is required in the aforementioned patients.īivalirudin is a small oligopeptide analog of hirudin acting on thrombin through direct inhibition. Management of this rare condition for patients requiring cardiopulmonary bypass (CPB) represents therapeutic challenges. Hypersensitivity reactions to heparin and heparin-like compounds are rare. However, each patient should be evaluated individually and it should not be forgotten that more than recommended doses may be needed. Bivalirudin may be recommended as a viable alternative anticoagulant in patients with heparin allergy during cardiopulmonary bypass. ConclusionĪlternative anticoagulation strategies are needed for cardiopulmonary bypass in patients unable to use heparin. After the surgery, the patient had an uneventful period in the postoperative intensive care unit with a total of 600ml and 300ml chest tube drainage for two days and was discharged on the 7th day. Also, mitral valve replacement with St Jude mechanical heart valve and tricuspid ring annuloplasty was performed with Medtronic Duran ring. Left anterior descending, obtuse marginal arteries and the right coronary artery were grafted with the left internal mammary and saphenous veins. Additional boluses of 0.5 mg/kg (50 mg) were administered for each measurement. Serial ACTs were obtained at 15-minute intervals during the procedure and the measurements were 330s, 320s, 350s, 360s, and 340s consecutively. A loading dose of 1.0 mg/kg (100 mg) bivalirudin was administered through the central line and a continuous infusion of 2.5 mg/kg/h of the anticoagulant was initiated following the approved protocol. Due to this allergy, we used bivalirudin (Bivacard VEM drug, Turkey) during the surgery. Heparin allergy was confirmed by skin biopsy and skin tests. Case ReportĪ 49-year-old male patient was admitted to our hospital for coronary artery bypass graft operation with mitral insufficiency and tricuspid valve insufficiency. Bivalirudin is a reversible direct thrombin inhibitor that can be used instead of heparin. ![]() Hypersensitivity reactions to heparin are uncommon conditions but pose a serious clinical problem for patients requiring cardiopulmonary bypass.
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