Quick Reference: Bivalirudin (Angiomax) Protocol for HIT
- Make sure to communicate with anesthesia to make
sure their central line and swan catheters are not heparin coated. - Cell saver anticoagulant is ACD or Bivalirudin at
0.1 mg/ml. - Standard amount of volume expander (Albumin) should be added to the prime.
- Pump prime: Add 50 mg after RAP. Continuously re-circulate prime after
administration. - Anesthesia loading dose: bolus of 1 mg/kg given
over 5 minutes. Administer at the same
time heparin normally would. - Constant infusion dose by anesthesia: 2.5 mg/kg/hr. Infusion can be adjusted in 0.25 mg/kg
increments. Discontinue 15 minutes prior
to coming off CPB. - If clot is seen at the field or in the circuit,
add a 25 mg bolus to the circuit. - ACT levels:
- Pre-CPB: 2.5 x baseline ACT.
- On CPB: 2.5 x baseline ACT, checked every 15 minutes.
- Check an ACT after infusion has stopped.
- Avoid stagnation in the CPB circuit. Keep purges open or re-circulate every 15
minutes. Cardioplegia should be
continuously re-circulated. - Realize that using a hemoconcentrator will lower
the bivalirudin level. - After coming off CPB, an additional 50 mg should
be added to the reservoir. Keep the
circuit re-circulating until it can be transferred to the cell saver for
processing.
