{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T08:16:03Z","timestamp":1773735363996,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T00:00:00Z","timestamp":1325808000000},"content-version":"vor","delay-in-days":1161,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2008,11]]},"abstract":"<jats:p>The temporary total artificial heart (TAH\u2010t) has emerged as an effective bridge to transplantation for individuals with biventricular failure. Implantation of a TAH\u2010t creates a hypercoagulable state requiring a multidrug approach that includes low\u2010dose unfractionated heparin (UFH) in order to minimize thromboembolism. A concern with UFH is the development of heparin\u2010dependent antibodies, which develop in up to 50% of patients receiving the drug as part of cardiopulmonary bypass. If UFH therapy continues postoperatively, the risk of heparin\u2010induced thrombocytopenia approaches 3%. Small investigations have demonstrated that bivalirudin, given as a bolus of 0.75\u20131 mg\/kg followed by an infusion at 1.75\u20102.5 mg\/kg\/hour, is an effective alternative to UFH for therapeutic anticoagulation during coronary artery bypass surgery, valve replacement, or both. We describe a series of five adults (age range 24\u201358 yrs) who received bivalirudin as an alternative to low\u2010dose UFH after TAH\u2010t implantation. None of the patients had documented heparin\u2010induced thrombocytopenia. Treatment was started at the discretion of the treating physician, and adjustments were based principally on the results of thromboelastography. Additional general monitoring included activated partial thromboplastin time, prothrombin time, international normalized ratio, fibrinogen, D\u2010dimer, platelet count, hemoglobin, hematocrit, and platelet aggregation studies. Bivalirudin therapy was continued until successful warfarin implementation. All five patients received bivalirudin in addition to standard antithrombotic therapy. Bivalirudin treatment started at a dosage of 0.005 or 0.01 mg\/kg\/hour with titration to maintain normocoagulability, which occurred (without concomitant warfarin therapy) within the dosage range of 0.01\u20100.02 mg\/kg\/hour. Duration of TAH\u2010t implantation was a mean of 38.8 days (range 25\u201360 days), and bivalirudin was continued for a mean of 15.2 days (range 7\u201324 days). No major hemorrhagic events occurred during treatment, and all patients successfully transitioned to warfarin therapy. Low\u2010dose bivalirudin, as an alternative to UFH, maintained normocoagulability after TAH\u2010t implantation. Further investigation is warranted to define the role and dosing of bivalirudin in this situation.<\/jats:p>","DOI":"10.1592\/phco.28.11.1413","type":"journal-article","created":{"date-parts":[[2008,10,29]],"date-time":"2008-10-29T07:35:01Z","timestamp":1225265701000},"page":"1413-1420","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Successful Use and Dosing of Bivalirudin After Temporary Total Artificial Heart Implantation: A Case Series"],"prefix":"10.1002","volume":"28","author":[{"given":"Michael A.","family":"Crouch","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vigeshwar","family":"Kasirajan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Cahoon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gundars J.","family":"Katlaps","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle J.","family":"Gunnerson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,1,6]]},"reference":[{"key":"e_1_2_1_2_2","unstructured":"SynCardia Systems Inc.CardioWest temporary total artificial heart (TAH\u2010t device) package insert. Tucson AZ;2004."},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040186"},{"key":"e_1_2_1_4_2","first-page":"341","article-title":"Platelet reactions with artificial surfaces","volume":"33","author":"Joist JH","year":"1987","journal-title":"ASAIO Trans"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-831044"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2004.12.008"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)00756-2"},{"key":"e_1_2_1_8_2","unstructured":"The Medicines Company.Angiomax (bivalirudin) package insert. 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