Bivalirudin infusion therapy during complete higher risk indicated percutaneous coronary intervention (CHIP) in heparin-induced thrombocytopenia and end-stage renal failure: a case report

In patients with heparin-induced thrombocytopenia (HIT), bivalirudin is the recommended anticoagulant for percutaneous coronary intervention (PCI). Herein, a successful case of bivalirudin infusion for an end-stage renal failure (ESRF) patient with HIT is described. This case details an ESRF patient with HIT who required a complete higher risk percutaneous indicated coronary intervention (CHIP) alongside an intra-aortic balloon pump (IABP). This case highlights a need for an established bivalirudin dosing titration protocol for cardiac procedures in an ESRF and HIT patient setting. We propose a dosing reference protocol of an IV bivalirudin bolus dose of 0.75mg/kg and an IV infusion dose of 0.50mg/kg/hr for CHIP procedures, with an activated clotting time (ACT) maintained to 250-350s and checked every 45 minutes. For anticoagulation post IABP, an IV infusion dose of 0.1mg/kg/hr is recommended, with activated partial thromboplastin time (aPTT) maintained at 50-70s every three hours.