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Review
. 2024 Oct;28(4):448-455.
doi: 10.1111/hdi.13181. Epub 2024 Oct 1.

Bivalirudin as an anticoagulation strategy for acute hemodialysis in children: Two cases with a summary of recent literature

Tanguy Viaene  1 , Evelyn Dhont  2 , Floris Vanommeslaeghe  3 , Sunny Eloot  3 , Filip De Somer  4 , Jonathan De Rudder  3 , Veerle Mondelaers  5 , Evelien Snauwaert  6
Affiliations
Review

Bivalirudin as an anticoagulation strategy for acute hemodialysis in children: Two cases with a summary of recent literature

Tanguy Viaene et al. Hemodial Int. 2024 Oct.

Abstract

Unfractionated heparin is the most used anticoagulative agent for extracorporeal settings in children, including acute hemodialysis modalities. In certain situations, such as heparin-induced thrombocytopenia, alternatives must be applied. The direct thrombin inhibitor bivalirudin has come forth as an attractive substitute. Bivalirudin is currently only approved for adult use in specific percutaneous coronary intervention settings. However, it has a growing off-label popularity in different contexts for both adult and pediatric patients. Experience with bivalirudin in children is mainly limited to extracorporeal membrane oxygenation, ventricular assist devices and during cardiopulmonary bypass surgery. Literature about its use as anticoagulation strategy for pediatric hemodialysis is very scarce. Here, we present two pediatric cases where bivalirudin was used during acute hemodialysis, followed by a short summary of recent literature.

Keywords: anticoagulation; bivalirudin; direct thrombin inhibitor; extracorporeal; hemodialysis; pediatric.

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