Successful use of bivalirudin in place of heparin infusion for pulmonary vein isolation using a cryoballoon catheter in a patient with heparin allergy

Ellis, Ethan R.

doi:10.1016/j.hrcr.2016.10.004

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…There are a few reports about successful bivalirudin use during ablation procedures in patients with HIT. 4 5 To the best of our knowledge, this is the first report of bivalirudin use in a patient undergoing a Mitraclip procedure.…”

Section: Discussionmentioning

confidence: 86%

Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia

Saia

Biagini

Berardini

et al. 2018

TH Open

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Interventional cardiology procedures require full anticoagulation to prevent thrombus formation on catheters and devices with potential development of embolic complications. Bivalirudin, a short half-life direct thrombin inhibitor, has been largely used during percutaneous coronary interventions and represents the preferred alternative to heparin in patients with heparin-induced thrombocytopenia (HIT). However, few data are available about intraprocedural use of bivalirudin during transcatheter structural heart disease interventions. Activated clotting time (ACT) monitoring during bivalirudin infusion presents some limitations and it is not mandatory. We report a case of bivalirudin use in a patient with type-2 HIT during percutaneous mitral valve repair with the Mitraclip system (Abbott, Abbott Park, Illinois, United States). Despite use of standard bivalirudin dose (0.75 mg/kg bolus and 1.4 mg/kg/min infusion—reduced infusion rate was motivated by a glomerular filtration rate of 37 mL/min), the patient developed a large thrombus on the second clip during its orientation toward the mitral orifice. ACT was measured at that time and was suboptimal (240 seconds). The case was successfully managed with clip and thrombus retrieval, adjunctive 0.3 mg/kg bivalirudin bolus and increased infusion rate, and clip repositioning with ACT monitoring. This report makes the case for mandatory ACT checking and drug titration during high-risk catheter–based structural heart disease interventions, even when thromboprophylaxis is performed with bivalirudin. Additional coagulation tests may be useful to monitor bivalirudin response in similar cases.

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Section: Discussionmentioning

confidence: 86%

Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia

Saia

Biagini

Berardini

et al. 2018

TH Open

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“…However, in analogy to the recommendations for coronary intervention, 6 bivalirudin can be successfully used for left sided CA procedures (Figure 1). This strategy has been confirmed by case reports of patients undergoing CA due to ventricular tachycardia and atrial fibrillation (AF) in patients with normal renal function, [10][11][12] and in patients with renal dysfunction in whom the bivalirudin dose was adjusted. 13 One procedure has been performed in a patient receiving apixaban.…”

Section: Resultsmentioning

confidence: 92%

“…13 One procedure has been performed in a patient receiving apixaban. 11 In all cases, drug administration was stopped at the end of the procedure and no adverse effects were registered.…”

Section: Resultsmentioning

confidence: 99%

Electrophysiological Procedures in Patients With Coagulation Disorders　― A Systemic Review ―

Krzowski

Balsam

Peller

et al. 2020

Circ J

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The aim of this review was to systematically analyze possible procedural risks and pitfalls depending on the underlying disease and provide clinical guidance based on the available literature. Because of the number of coagulation disorders and the lack of data regarding CA in specific disorders, we focused on the most common coagulation disorders, namely heparin-induced thrombocytopenia (HIT), hemophilia, heterozygous Factor V (FV) Leiden mutation, von Willebrand Disease (vWD), light chain amyloidosis, antiphospholipid syndrome, myelodysplastic syndrome, immune-mediated disorders and hereditary hemorrhagic telangiectasia. MethodsThis systematic review was conducted in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.A systematic search was performed of the PubMed database from inception to April 2019. The search strategy focused on identifying studies and case reports that described electrophysiological procedures in patients with coagulopathies. The reference lists of the included articles and other published reviews were also examined to identify

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“…Secondly, the use of bivalirudin during catheter ablation has only been reported in patients with normal renal function using percutaneous coronary intervention dosing. 12 , 13 , 14 Although this case demonstrates that bivalirudin may be safe and effective in patients with anuric renal failure and a BIVAD, the standard hemodialysis-adjusted dosing may not be enough to maintain therapeutic ACT. This suggests that in longer left-sided procedures in the setting of renal failure, it may be necessary to titrate standard renal bivalirudin dosing to maintain adequate anticoagulation levels.…”

Section: Discussionmentioning

confidence: 91%

Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin

Successful use of bivalirudin in place of heparin infusion for pulmonary vein isolation using a cryoballoon catheter in a patient with heparin allergy

Cited by 6 publications

References 11 publications

Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia

Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia

Electrophysiological Procedures in Patients With Coagulation Disorders　― A Systemic Review ―

Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin

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Successful use of bivalirudin in place of heparin infusion for pulmonary vein isolation using a cryoballoon catheter in a patient with heparin allergy

Cited by 6 publications

References 11 publications

Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia

Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia

Electrophysiological Procedures in Patients With Coagulation Disorders ― A Systemic Review ―

Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin

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Electrophysiological Procedures in Patients With Coagulation Disorders　― A Systemic Review ―