What anticoagulant is used for HIT?

What anticoagulant is used for HIT?

A direct thrombin inhibitor, such as lepirudin, danaparoid or argatroban, is considered the agent of choice for treatment of HIT. Warfarin should not be used until the platelet count has recovered.

What is bivalirudin used for?

Bivalirudin is a medication used to manage and treat patients undergoing percutaneous coronary intervention for acute myocardial infarction.

Does bivalirudin affect act?

The approved product labeling for Angiomax states that, in adults, IV bivalirudin produces dose- dependent prolongation of anticoagulant activity as measured by activated partial thromboplastin time (aPTT), thrombin time (TT), prothrombin time (PT), and activated clotting time (ACT).

In which patients should bivalirudin be avoided?

Clearance was reduced by approximately 20% in patients with moderate and severe renal impairment and by approximately 80% in dialysis-dependent patients. Bivalirudin should therefore be used with caution in the presence of renal dysfunction in order to avoid protracted postsurgical bleeding.

Is bivalirudin approved for HIT?

Bivalirudin is the most recent direct thrombin inhibitor to be introduced to the market, but it is not currently FDA approved for HIT.

What is bivalirudin made from?

Bivalirudin (Bivalitroban), sold under the brand names Angiomax and Angiox and manufactured by The Medicines Company, is a direct thrombin inhibitor (DTI). Chemically, it is a synthetic congener of the naturally occurring drug hirudin, found in the saliva of the medicinal leech Hirudo medicinalis.

Is bivalirudin approved for hit?

Does bivalirudin require routine monitoring?

With the exception of desirudin and dabigatran etexilate, the remaining parenteral DTIs (argatroban, bivalirudin, and lepirudin) require routine laboratory monitoring of their therapeutic effect while balancing the risk of bleeding with that of clinical efficacy.

How do you monitor bivalirudin?

At UWMC, bivalirudin is monitored using the Direct Thrombin Inhibitor (DTI) assay (Plasma-Diluted Thrombin Time). Used instead of aPTT to monitor injectable DTI therapy. Preferred over aPTT due to better sensitivity, and is not affected by antiphospholipid antibodies.

What is POCT activated clotting time?

POC | Activated Clotting Time, POC Guidelines for normal Activated Clotting Time without the presence of heparin are 90-120 seconds. After heparinzation, the level of acceptable ACT varies according to the procedure. 1.

What is the aPTT goal for bivalirudin?

Bivalirudin infusions were initiated at 0.05 to 0.3 mg/kg/hr. The aPTT goals were determined for each patient individually based on underlying disease and risk factors. The median time to achieve an aPTT level within the goal range was 4 hours, with a range of 1 to 25 hours.

Is bivalirudin a thrombolytic?

In addition, the drug has shown potential in the treatment of patients with unstable angina not undergoing PCI. For patients with MI, it is clear that bivalirudin can replace heparin in the management of MI where streptokinase is used as the thrombolytic agent.

What should be the initial dose of bivalirudin?

Bivalirudin initial dosing guide: (Note this is not the package insert dose)  Range: 0.03-0.2 mg/kg/hr o If deemed necessary by physician, bolus dose: 0.1-0.2 mg/kg.  Dose reduction is recommended in patients with hepatic or renal failure, critically ill or very high bleeding risk—please see below for guidance.

Can a bivalirudin infusion cause a false positive?

GUIDELINE FOR BIVALIRUDIN DOSING IN HIT/HITTS  Do not stop the DTI infusion simply because the INR increases (no warfarin); If the INR exceeds baseline INR by 0.5 with an aPTT that is not excessively elevated, call the pharmacy for further assessment. DTI including Bivalirudin can cause a false positive increase in the INR.

How is bivalirudin different from argatroban in cardiac surgery?

Bivalirudin, however, outside the context of cardiac surgery, has been used for anticoagulation during RRT in HIT and non-HIT patients. 52 In contrast to argatroban, pharmacokinetics are influenced by renal function. Furthermore, bivalirudin is cleared through RRT itself.

How is bivalirudin cleaved by thrombin in proteolysis?

Bivalirudin is cleaved by thrombin via proteolysis. This represents the major elimination mechanism of bivalirudin. Modified from Lee CJ, Ansell JE: Direct thrombin inhibitors. Br J Clin Pharmacol 2011; 72:581–92.