{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:51:17Z","timestamp":1747187477825,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T00:00:00Z","timestamp":1701820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Bivalirudin is recommended as an alternative to heparin in cardiac surgery with cardiopulmonary bypass. Although it has been used in infants and children for this indication, there is a paucity of data on the pharmacologic effects of bivalirudin in neonates. Given the immaturity of the hemostatic system in neonates, we hypothesized that coagulation responses to bivalirudin in this population would be different than in adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Blood samples were drawn from placenta\u2010cord units and from healthy adult donors. The study was carried out in two steps. First, bivalirudin was added to cord and adult blood samples at concentrations of 0, 5, 10, 15, and 20\u2009\u03bcg\/mL. Activated clotting time and thromboelastographic variables were recorded. Next, we used a Chandler loop system to assess the efficacy of bivalirudin in a simple model of cardiopulmonary bypass. The loops were primed with cord or adult blood and were run until thrombus was detected. Plasma bivalirudin concentrations were measured at 1, 15, 30, 45, 60, and 75\u2009min after initiating rotation of the loops using liquid chromatography\/mass spectrometry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Bivalirudin elicited a dose\u2010dependent prolongation inhibition of coagulation in both cord and adult blood samples with greater potency in cord blood in comparison to adult blood (activated clotting time: 627\u2009\u00b1\u200950 vs. 452\u2009\u00b1\u200922\u2009s at 15\u2009\u03bcg\/mL bivalirudin, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). This relative potency was also demonstrated in the Chandler loop system, but interestingly, cord blood appeared to inactivate bivalirudin more rapidly than adult blood with earlier clotting in loops containing cord blood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates that bivalirudin has greater potency in cord blood in\u00a0vitro than in adult blood. Plasma degradation appears to proceed more rapidly in cord blood than in adults. Both of these findings should be considered when planning dosing regimens in neonatal patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14814","type":"journal-article","created":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T02:20:44Z","timestamp":1701915644000},"page":"415-421","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of bivalirudin on coagulation in neonatal (cord) and adult human blood in\u00a0vitro"],"prefix":"10.1111","volume":"34","author":[{"given":"Sergiy M.","family":"Nadtochiy","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of Rochester School of Medicine and Dentistry  Rochester New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsiana","family":"Stefanos","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of Rochester School of Medicine and Dentistry  Rochester New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Wissler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of Rochester School of Medicine and Dentistry  Rochester New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of Rochester School of Medicine and Dentistry  Rochester New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changyong","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Computational Biology University of Rochester School of Medicine and Dentistry  Rochester New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Lebedko","sequence":"additional","affiliation":[{"name":"School of Medicine SUNY Upstate Medical University  Syracuse New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3705-9933","authenticated-orcid":false,"given":"Michael P.","family":"Eaton","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine University of Rochester School of Medicine and Dentistry  Rochester New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0677"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13057"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028020937819"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002835"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2020.01.020"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2018.04.028"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2022.04.044"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2006.08.005"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0267659111419037"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/201648039"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/IMCRJ.S118250"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2005.09.057"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0267659118767374"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2020.05.020"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200302000-00015"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14125"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004537"},{"key":"e_1_2_9_19_1","article-title":"The 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