Bivalrudin use in off-pump myocardial revascularization in patients with heparin-induced thrombocytopenia

With advances in therapy of acute coronary syndromes, repetitive exposure to heparin has become commonplace. Consequently, the incidence of heparin-induced thrombocytopenia has risen. Limited strategies for management exist, and new thrombin inhibitors may provide safe alternatives to heparin. Two patients with documented heparin-induced thrombocytopenia underwent revascularization using a new thrombin inhibitor (Bivalrudin [Angiomax, Medicines Co, Cambridge, MA]) for anticoagulation. Both patients had uneventful perioperative hospitalizations. Thrombin inhibition with Bivalrudin (Angiomax) may provide a safe reliable alternative to heparin use in cardiac surgery.