Presentation Details
| Monitoring bivalirudin anticoagulant effect by the addition of diluted thrombin time compared to activated partial thromboplastin time alone Vadim Kostousov, Karen Bruzdoski, Jun Teruya. Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA |
Abstract
Background: Bivalirudin is gradually replacing unfractionated heparin for extracorporeal life support (ECLS) anticoagulation. Only activated partial thromboplastin time (aPTT, with heparinase HPTT) was utilized in our hospital as a main assay to monitor bivalirudin therapy until 2022. Since 2023 plasma diluted thrombin time (dTT) was implemented in routine coagulation analysis as the additional test for monitoring bivalirudin effect. Objectives: Our study aimed to compare bivalirudin infusion rate (BIR), HPTT, and bivalirudin levels measured by dTT before (2022) and after (2023) dTT implementation among infants on ECLS. Methods: HPTT, dTT and BIR values were extracted from the hospital database from patients younger than 3 years old on ECLS from January 2022 to November 2023; dTT was measured on STA-R-Max analyzer (Diagnostica Stago, USA) in stored specimens before implementation of dTT assay in 2022. Bivalirudin level at 0.8-2.5 µg/mL was considered as target range equivalent to goal HPTT interval of 60-80 sec based on in vitro spiking experiments. Statistical analysis was performed with Mann-Whitney U-test, two proportion Z-test using MS-Excel 2016; data is presented as mean±SD, with significance at p<0.05. Results: Total 169 specimens from 16 pediatric patients aged 0.4-35 months were analyzed: HPTT and bivalirudin concentration became significantly higher, once dTT was introduced into routine analysis (Table). This was accompanied with 1.5-time increase of drug infusion rate. Majority of specimens were within target range of bivalirudin level and fewer of them had extremely high values after dTT implementation. Conclusions: The implementation of new test for bivalirudin monitoring was accompanied with increased drug infusion rate and more precise goal attainment during ECLS. If this targeted therapy would lead to an improved clinical outcome deserves further study.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.