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Evaluation of Intraoperative Bivalirudin Anticoagulation in Neonates and Infants Undergoing Arterial Switch Operation
Mohanish Badge1, Suruchi Hasija1, Sandeep Chauhan1
1Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Objectives:
To ascertain the dosage of bivalirudin in neonates and infants undergoing arterial switch operation on integrated extracorporeal membrane oxygenation-cardiopulmonary bypass (CPB) circuit.
Design:
Pilot study.
Setting:
A tertiary care hospital.
Participants:
Ten neonates and infants with transposition of great arteries undergoing an arterial switch operation INTERVENTIONS: The patients received a bivalirudin bolus dose of 1 mg/kg followed by a maintenance dose of 2.5 mg/kg/h. The infusion dose was adjusted to maintain an activated clotting time (ACT) >480 s.
Measurements And Main Results:
The mean age and weight were 92 ± 67 days and 4.1 ± 1.45 kg, respectively. There were more male children than female (8:2). The mean baseline ACT score was 207.6 ± 52.4 s. The bolus dose required was 1 mg/kg, and two children required an additional bolus dose of 0.5 mg/kg. The mean ACT of the priming solution was 999 s, and the mean ACT following the bolus dose was 575.9 ± 101 s. The maintenance dose required was 2.1 ± 0.3 mg/kg/h. The mean ACT on CPB after 30 min, 60 min, and 90 min was 956.2 ± 62.8 s, 936.8 ± 137 s, and 829.6 ± 232.5 s, respectively. There was no incidence of clot formation in the circuit or thromboembolic complications.
Conclusions:
Bivalirudin can be effectively used for anticoagulation during CPB in neonates and infants with transposition of great arteries, at a bolus dose of 1 mg/kg and a maintenance dose of 2.1 ± 0.3 mg/kg/h, utilizing the integrated extracorporeal membrane oxygenation-CPB circuit.
