Bivalirudin as rescue therapy for suspected heparin resistance and recurrent intra-procedural stent thrombosis during complex percutaneous coronary intervention: a case report - Scorecard - MDSpire
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Bivalirudin as rescue therapy for suspected heparin resistance and recurrent intra-procedural stent thrombosis during complex percutaneous coronary intervention: a case report
Clinical Scorecard: Utilization of Bivalirudin as an Alternative Treatment for Suspected Heparin Resistance and Ongoing Intra-Procedural Stent Thrombosis in Complex Percutaneous Coronary Interventions: A Case Study
At a Glance
Category
Detail
Condition
Heparin Resistance during Percutaneous Coronary Intervention
Key Mechanisms
Antithrombin III deficiency, elevated factor VIII, nonspecific heparin binding
Target Population
Patients undergoing complex PCI with suspected heparin resistance
Care Setting
Cardiac catheterization laboratory
Key Highlights
Bivalirudin effectively achieved therapeutic anticoagulation in a patient with suspected heparin resistance.
Subtherapeutic anticoagulation persisted despite a cumulative unfractionated heparin dose of 11,000 U.
Bivalirudin led to rapid thrombus resolution during complex PCI.
The case emphasizes the importance of timely recognition of heparin resistance.
Gastrointestinal complications were noted following bivalirudin administration.
Guideline-Based Recommendations
Diagnosis
Monitor activated clotting time (ACT) to assess anticoagulation levels.
Management
Consider switching to bivalirudin in cases of suspected heparin resistance.
Monitoring & Follow-up
Regularly assess ACT during PCI procedures.
Risks
Potential for gastrointestinal complications with bivalirudin.
Patient & Prescribing Data
67-year-old male with a history of atrial fibrillation and complex coronary artery disease.
Bivalirudin was administered as a bolus followed by a continuous infusion to manage heparin resistance.
Clinical Best Practices
Recognize signs of heparin resistance early during PCI.
Utilize bivalirudin as a rescue therapy in cases of recurrent stent thrombosis.
