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Updated: Jun 9, 2026

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Published on: June 12, 2021

Bivalirudin burst dosing in children supported with paracorporeal ventricular assist devices: A single-center

Benjamin A Olsen1, Robert W Hyslop2, Rhynn J Soderstrom3

  • 1Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Children's Hospital Colorado Heart Institute, Aurora, CO.

JHLT Open
|June 8, 2026
PubMed

Insights

Bivalirudin burst dosing may be a safe strategy for pediatric patients on paracorporeal ventricular assist devices (VADs). This approach showed no increased risk of bleeding or thrombotic events in a small case series.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • Children with paracorporeal ventricular assist devices (VADs) face high risks of thrombotic complications.
  • Current anticoagulation strategies, including heparin, have limitations in managing these risks.
  • Bivalirudin, a direct thrombin inhibitor, is being explored as an alternative anticoagulation therapy.

Purpose of the Study:

  • To evaluate the feasibility and safety of a bivalirudin burst dosing protocol in pediatric patients with paracorporeal VADs.
  • To assess the temporal relationship between bivalirudin bursts and adverse thrombotic or bleeding events.

Main Methods:

  • A retrospective case series of 9 pediatric patients supported with paracorporeal VADs.
  • Implementation of a bivalirudin burst dosing protocol (20%-50% dose increase per hour for 2 hours) to manage thrombus deposition.
  • Monitoring for bleeding and thromboembolic events within specific timeframes following bivalirudin bursts.

Main Results:

  • A total of 132 bivalirudin bursts were administered across the patient cohort.
  • No bleeding events were observed within 12 hours post-burst.
  • No thromboembolic events were recorded within 48 hours post-burst.

Conclusions:

  • Bivalirudin burst dosing appears feasible and safe in this pediatric VAD population.
  • The protocol was not associated with an increased incidence of adverse bleeding or thrombotic events.
  • Further prospective studies are needed to confirm safety, optimize dosing, and establish standardized criteria for bivalirudin burst initiation.

Keywords:
AnticoagulationBivalirudinPediatric heart failurePediatric mechanical circulatory supportStrokeVentricular assist device

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