CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS 2022; 06(01): 054-058
DOI: 10.1055/s-0042-1750011
Review Article

Perfusion Strategies for Bivalirudin Anticoagulation: AIIMS Protocol

Gaurav Sharma
1   Department of Perfusion Technology, All India Institute of Medical Sciences, New Delhi, India
,
Suruchi Hasija
2   Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Poonam Malhotra Kapoor
2   Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
› Institutsangaben

Abstract

Anticoagulation strategies for cardiac surgery are witnessing a change with the identification of serious limitations of heparin, including development of resistance in 3 to 13% of patients undergoing cardiac surgery and heparin-induced thrombocytopenia/thrombosis syndrome in 1 to 5.5% of patients. Heparin alternatives have a potential role in these scenarios. Bivalirudin, a reversible direct thrombin inhibitor, has an onset time of 2 to 4 minutes and half-life of 25 minutes, is eliminated mainly by a proteolytic mechanism, does not require antithrombin III for effect, and is nonimmunogenic. The considerations for extracorporeal circulation are peculiar with its use, and this article outlines the aspects of initiating, maintaining, and terminating cardiopulmonary bypass and extracorporeal membrane oxygenation with bivalirudin as the anticoagulant.

Disclaimer

The protocol presented herein is followed at the authors' institution and readers may adopt the practical suggestions as per their discretion. The ECMO circuit is improvised to make it less complicated and easy to manage by using fewer connectors, stopcocks, and avoiding potential sites of flow turbulence and blood stasis.




Publikationsverlauf

Artikel online veröffentlicht:
01. Juni 2022

© 2022. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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