A Review of Bivalirudin for Pediatric and Adult Mechanical Circulatory Support

Taylor, Tori; Campbell, Christopher T.; Kelly, Brian

doi:10.1007/s40256-020-00450-w

Cited by 18 publications

(20 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hirudin-1isthe first-known and most well-studied natural bivalent thrombin inhibitor withinhibitions constants of about 200 fM.The structure of hirudin-1 includes a [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]-core domain that binds to the thrombin active site and unstructured [ 55 , 56 , 57 , 58 , …”

Section: Discussionmentioning

confidence: 99%

“…Bivalirudin has been certified and used for a long time for treatment of patients with, or at risk of, heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) undergoing percutaneous coronary intervention and of patients with unstable angina pectoris after percutaneous transluminal coronary angioplasty [ 24 , 25 ]. Although bivalirudin is not currently fully FDA-approved for use in pediatric patients, it is widely used for systemic anticoagulation during the therapy of pediatric patients requiring Extracorporeal Membrane Oxygenation (ECMO) [ 26 , 27 , 28 ]. The U.S. Food and Drug Administration (FDA) has granted the pediatric exclusivity for bivalirudin, based on the prospective, open-label, multi-center, single arm study submitted in response to a written request by the FDA to investigate the use of bivalirudin in pediatric patients aged birth to 16-year old [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Screening of the Promising Direct Thrombin Inhibitors from Haematophagous Organisms. Part I: Recombinant Analogues and Their Antithrombotic Activity In Vitro

et al. 2021

View full text Add to dashboard Cite

The success in treatment of venous thromboembolism and acute coronary syndromes using direct thrombin inhibitors has stimulated research aimed at finding a new anticoagulant from haematophagous organisms. This study deals with the comparison between hirudin-1 from Hirudomedicinalis(desirudin), being the first-known and most well-studied natural anticoagulant, along with recombinant analogs of haemadin from the leech Haemadipsa sylvestris, variegin from the tick Amblyomma variegatum, and anophelin from Anopheles albimanus. These polypeptides were chosen due to their high specificity and affinity for thrombin, as well as their distinctive inhibitory mechanisms. We have developed a universal scheme for the biotechnological production of these recombinant peptides as pharmaceutical substances. The anticoagulant activities of these peptides were compared using the thrombin amidolytic activity assay and prolongation of coagulation time (thrombin time, prothrombin time, and activated partial thromboplastin time) in mouse and human plasma. The preliminary results obtained suggest haemadin as the closest analog of recombinant hirudin-1, the active substance of the medicinal product Iprivask (Aventis Pharmaceuticals, USA) for the prevention of deep venous thrombosis in patients undergoing elective hip or knee replacement surgery. In contrast, variegin can be regarded as a natural analog of bivalirudin (Angiomax, The Medicines Company), a synthetic hirudin-1 derivative certified for the treatment of patients undergoing percutaneous coronary intervention and of patients with unstable angina pectoris after percutaneous transluminal coronary angioplasty.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Screening of the Promising Direct Thrombin Inhibitors from Haematophagous Organisms. Part I: Recombinant Analogues and Their Antithrombotic Activity In Vitro

et al. 2021

View full text Add to dashboard Cite

show abstract

“…5–7 Alternative AC strategies have not been well defined for patients supported with tMCS intolerable to UFH, but there are recent reports of bivalirudin use in patients on percutaneous tMCS. 8–12…”

Section: Introductionmentioning

confidence: 99%

Outcomes of systemic anticoagulation with bivalirudin for Impella 5.0

et al. 2021

View full text Add to dashboard Cite

Temporary mechanical circulatory support (tMCS) devices are used for the management of cardiogenic shock. The Impella 5.0 (Abiomed; Danvers, MA) (IMP5) is a commonly used, surgically implanted, tMCS device that requires systemic anticoagulation and purge solution to avoid pump failure. To avoid heparin-induced thrombocytopenia (HIT) from unfractionated heparin (UFH) use, our program has explored the utility of bivalirudin (BIV) for systemic anticoagulation in IMP5. This single center, retrospective study included patients supported on IMP5 with BIV based AC. The efficacy and safety end points were recovery, bridge to left ventricular assist device (LVAD), cardiac transplant (HTX), or death as well as clinically significant bleeding, incidence of Tissue Plasminogen Activator (tPA) use for suspected pump thrombosis, stroke, and device failure. There were 31 patients included, and 26 (84%) received BIV purge solutions. The median duration of IMP5 was 6 (IQR 4–10) days. Most patients were bridged to LVAD (39%, 12); 16% (5) were bridged to HTX, 16% (5) recovered, and 29% (9) died. One patient (3%) suffered from ischemic stroke and 12% (4) patients developed clinically significant bleeding. tPA was administered to 8 (26%) patients. Logistic regression analysis demonstrated that duration of IMP5 was a significant predictor of tPA use (OR 1.28; 95% Confidence Interval 1.04–1.56). There were no cases of pump failure. Our experience highlights the feasibility of utilizing BIV for routine AC use in IMP5.

show abstract

“…Therefore, a direct thrombin inhibitor, bivalirudin, may be used as an alternative anticoagulant for ECMO in the setting of heparin resistance. Recently, bivalirudin is emerging as a more frequently used anticoagulant in ECLS support 2 . Bivalirudin has a short half‐life of 20–25 min due to its intravascular proteolysis and minimal renal clearance (~20%) 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Recently, bivalirudin is emerging as a more frequently used anticoagulant in ECLS support. 2 Bivalirudin has a short half-life of 20-25 min due to its intravascular proteolysis and minimal renal clearance (~20%). 3 In some institutions, VAD is managed using only bivalirudin as the primary anticoagulant.…”

mentioning

confidence: 99%

How to best monitor bivalirudin anticoagulant effect for ECMO and VAD—Comparison of four assay methods

Teruya

Bruzdoski

Hensch

et al. 2021

Int J Lab Hematology

View full text Add to dashboard Cite

Unfractionated heparin (heparin hereafter) has historically been the widely used anticoagulant for extracorporeal life support (ECLS) such as extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD). However, we occasionally encounter clinical or laboratory heparin resistance despite an adequate heparin dose and antithrombin level. 1 Even when the heparin infusion rate is >40 units/kg/hour, occasionally clots are observed in the ECMO circuit or the anti-factor Xa (anti-Xa) level does not achieve the desired target. In addition, since the anticoagulant action of heparin is mediated by the formation of complexes with antithrombin and

show abstract

A Review of Bivalirudin for Pediatric and Adult Mechanical Circulatory Support

Cited by 18 publications

References 32 publications

Screening of the Promising Direct Thrombin Inhibitors from Haematophagous Organisms. Part I: Recombinant Analogues and Their Antithrombotic Activity In Vitro

Screening of the Promising Direct Thrombin Inhibitors from Haematophagous Organisms. Part I: Recombinant Analogues and Their Antithrombotic Activity In Vitro

Outcomes of systemic anticoagulation with bivalirudin for Impella 5.0

How to best monitor bivalirudin anticoagulant effect for ECMO and VAD—Comparison of four assay methods

Contact Info

Product

Resources

About