naa a22 4500 510800033 CHVBK 20180411083351.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s12028-013-9835-0 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9835-0 Bivalirudin as a Bridge for Anticoagulation in High Risk Neurosurgical Patients with Active DVT or High Risk of Thrombosis [Elektronische Daten] [Tariq Janjua, Eric Nussbaum, Jodi Lowary, Virginia Babbini] Background: Bivalirudin is an ultrashort acting direct thrombin inhibitor, which has been used in place of heparin in selected settings. We describe our preliminary experience with the use of bivalirudin in patients who required anticoagulation for a deep vein thrombosis, prosthetic heart valve, or hypercoagulable state but were felt to be at high risk for the use of heparin. Methods: Eight patients in our neurocritical care unit required anticoagulation but were felt to be poor candidates for heparin either due to heparin-induced thrombocytopenia or due to high risk for intracranial hemorrhage. A standard protocol was utilized for bivalirudin with a loading dose of 0.75mg/kg followed by a continuous infusion of 0.15mg/kghr. Serial aPTT levels were checked on a routine basis to monitor therapeutic effect. The bivalirudin infusion was continued for a period of 2days to 2weeks prior to starting coumadin therapy. Results: These patients were in the early postoperative period (within 48h) following craniotomy, had suffered a recent large hemispheric infarct with hemorrhagic conversion, or had presented with an acute intracerebral hemorrhage. In this small series of patients, no intracranial hemorrhagic complications were encountered. No patients demonstrated progressive systemic thrombotic issues while on bivalirudin. Conclusion: Based on these findings, bivalirudin may represent a reasonable alternative in patients for whom heparin anticoagulation is contraindicated. A larger multicenter trial of bivalirudin in this setting may be appropriate Springer Science+Business Media New York, 2013 Direct thrombin inhibitors nationallicence Intracranial hemorrhage nationallicence Bivalirudin nationallicence Deep venous thrombosis nationallicence Prosthetic cardiac valve nationallicence Janjua Tariq National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut Nussbaum Eric National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut Lowary Jodi National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut Babbini Virginia National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut Neurocritical Care Humana Press Inc 18/3(2013-06-01), 349-353 1541-6933 18:3<349 2013 18 12028 https://doi.org/10.1007/s12028-013-9835-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9835-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Janjua Tariq National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut NATIONALLICENCE 700 1- Nussbaum Eric National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut NATIONALLICENCE 700 1- Lowary Jodi National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut NATIONALLICENCE 700 1- Babbini Virginia National Brain Aneurysm Center, Saint Joseph's Hospital, 55102, Saint Paul, MN, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/3(2013-06-01), 349-353 1541-6933 18:3<349 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer