Bivalirudin dosing during prolonged intermittent renal replacement therapy: a case report

Area of Science:

• Nephrology
• Pharmacology
• Critical Care Medicine

Background:

• Medications cleared by dialysis, especially those with a narrow therapeutic index, often require dose adjustments during and between dialysis sessions.
• Transitions in dialysis modalities and between intra-dialytic and inter-dialytic periods pose challenges for medication management.

Observation:

• This report details three cases of patients receiving the anticoagulant bivalirudin during a transition from continuous to prolonged intermittent renal replacement therapy.
• Specific details on dialysis flow rates and ultrafiltrate volume were recorded for each case.

Findings:

• In the observed cases, pre-emptive dose adjustments for bivalirudin appeared unnecessary during the transition between dialysis modalities.
• Potential for rebound anticoagulant effect after cessation of dialysis was noted.

Implications:

• Clinicians should exercise caution and consider close monitoring rather than routine pre-emptive dose reduction of bivalirudin when patients switch dialysis methods.
• Awareness of potential rebound anticoagulation is crucial for patient safety during post-dialysis periods.