{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:00Z","timestamp":1786944300215,"version":"build-2736575974"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Pediatrics"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Unfractionated heparin remains the standard anticoagulant for pediatric cardiac procedures, but its drawbacks in children are hard to ignore. Because it works through antithrombin, its effect is unpredictable, dosing is difficult to titrate, and it carries the risk of heparin-induced thrombocytopenia (HIT). Bivalirudin, a direct thrombin inhibitor, inhibits thrombin without needing antithrombin. The pediatric evidence, though, is thin. Beyond one cardiac surgery trial and a few catheterization studies, most work comes from ECMO, along with growing use in pediatric ventricular assist device (VAD) support, where direct thrombin inhibitors have replaced heparin and now feature in society guidance. These studies show bivalirudin is feasible and predictable, but not that it consistently beats heparin. For now, its clearest role is in children who cannot tolerate heparin or whose anticoagulation is unstable. The field needs multicenter randomized trials, agreed-upon protocols, and monitoring built for children.<\/jats:p>","DOI":"10.1177\/30502225261479091","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T22:15:04Z","timestamp":1786659304000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bivalirudin as an Alternative to Heparin in Pediatric Cardiac Procedures: Evidence, Challenges, and Future Directions"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8134-4448","authenticated-orcid":false,"given":"Abdul","family":"Basit","sequence":"first","affiliation":[{"name":"Department of Pediatrics, King Edward Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahzaib","family":"Khaliq","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Edward Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharaz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Edward Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saira","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Bolan Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Naeem","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, SUNY Downstate Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8832-1262","authenticated-orcid":false,"given":"Majeed","family":"Haq","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Shaheed Suhrawardy Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(98)00159-2"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.24.2994"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-10-378984"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.03746.x"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2011.03541.x"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000147536.76194.43"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.01.088"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0708191"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2021.04.015"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001921"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2019.01.1090"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2026.03.617"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003480"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.4103\/aca.ACA_140_17"},{"issue":"4","key":"e_1_3_3_16_2","first-page":"231","article-title":"Bivalirudin as an alternative to heparin in pediatric cardiac surgery: initial experience","volume":"42","author":"Guzzetta NA","year":"2010","unstructured":"Guzzetta NA, Foster GS, Mruthinti N, Miller BE. Bivalirudin as an alternative to heparin in pediatric cardiac surgery: initial experience. J Extra Corpor Technol. 2010;42(4):231-236.","journal-title":"J Extra Corpor Technol"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.22775"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.02.011"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1137134"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1772838"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/FJC.0000000000001633"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003642"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004953"},{"issue":"5","key":"e_1_3_3_24_2","first-page":"767","article-title":"Monitoring of bivalirudin anticoagulation with the activated clotting time","volume":"87","author":"Koster A","year":"2002","unstructured":"Koster A, Chew D, Grundel M, Bauer M, Kuppe H, Hetzer R. Monitoring of bivalirudin anticoagulation with the activated clotting time. Thromb Haemost. 2002;87(5):767-771.","journal-title":"Thromb Haemost"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003495"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003494"}],"container-title":["Sage Open Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/30502225261479091","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/30502225261479091","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/30502225261479091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:46:57Z","timestamp":1786942017000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/30502225261479091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":25,"alternative-id":["10.1177\/30502225261479091"],"URL":"https:\/\/doi.org\/10.1177\/30502225261479091","relation":{},"ISSN":["3050-2225","3050-2225"],"issn-type":[{"value":"3050-2225","type":"print"},{"value":"3050-2225","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"30502225261479091"}}