• G Ital Cardiol (Rome) · Feb 2013

    Case Reports

    [Optimal dose of bivalirudin in dialysis patients at high risk of heparin-induced thrombocytopenia undergoing percutaneous coronary intervention: case report].

    • Maria Francesca Notarangelo, Lucia Coppini, Federico Bontardelli, Francesca Boffetti, Luigi Vignali, and Diego Ardissino.
    • Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliero, Universitaria di Parma, Italy. francescanotarangelo@yahoo.it
    • G Ital Cardiol (Rome). 2013 Feb 1; 14 (2): 141-4.

    AbstractBivalirudin is a direct thrombin inhibitor that has been approved for use in patients with or at risk for heparin-induced thrombocytopenia undergoing percutaneous coronary intervention. The efficacy of bivalirudin has been well documented in the setting of percutaneous coronary intervention, but there are only few data on its use in chronic dialysis-dependent patients. Bivalirudin is mainly eliminated enzymatically (80%) and to a lesser extent renally (20%). Nevertheless, in patients with chronic kidney disease a substantial increase in coagulation time and bleeding complications has been reported. Therefore, dosage adjustments may be necessary in patients with renal impairment. Dosing and monitoring recommendations in dialysis patients have not yet been established. We describe the case of a 77-year-old man with non-ST-elevation acute coronary syndrome complicated by heparin-induced thrombocytopenia and acute renal failure requiring dialysis treatment. During percutaneous coronary intervention, anticoagulant therapy with bivalirudin was administered at non-standard doses, though already documented in the literature.

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