The Use of Bivalirudin in Pediatric Cardiac Surgery and in the Interventional Cardiology Suite

Dheeraj Goswami, Matthew DiGiusto, Rajeev Wadia, Sean Barnes, Jamie Schwartz, Diana Steppan, Kristen Nelson-McMillan, Richard Ringel, Jochen Steppan

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Anticoagulation is an essential component for patients undergoing cardiopulmonary bypass or extracorporeal membrane oxygenation and for those with ventricular assist devices. However, thrombosis and bleeding are common complications. Heparin continues to be the agent of choice for most patients, likely owing to practitioners’ comfort and experience and the ease with which the drug's effects can be reversed. However, especially in pediatric cardiac surgery, there is increasing interest in using bivalirudin as the primary anticoagulant. This drug circumvents certain problems with heparin administration, such as heparin resistance and heparin-induced thrombocytopenia, but it comes with additional challenges. In this manuscript, the authors review the literature on the emerging role of bivalirudin in pediatric cardiac surgery, including its use with cardiopulmonary bypass surgery, extracorporeal membrane oxygenation, ventricular assist devices, and interventional cardiology. Moreover, they provide an overview of bivalirudin's pharmacodynamics and monitoring methods.

Original languageEnglish (US)
Pages (from-to)2215-2223
Number of pages9
JournalJournal of cardiothoracic and vascular anesthesia
Issue number8
StatePublished - Aug 2020


  • ECMO
  • anticoagulation
  • bivalirudin
  • cardiopulmonary bypass
  • pediatric cardiac surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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