Bivalirudin during thrombolysis with catheter-directed tPA in a heparin-refractory patient: A case report

Pediatr Blood Cancer. 2020 Feb;67(2):e28094. doi: 10.1002/pbc.28094. Epub 2019 Nov 20.

Abstract

Venous thromboembolism has increasing significance in hospitalized pediatric patients. Patients who have life-threatening or limb-threatening thrombotic events require thrombolysis in addition to anticoagulation. In patients who show signs of heparin resistance or heparin-induced thrombocytopenia, it is imperative to identify alternative therapeutic options. We present a child in whom bivalirudin was used for systemic anticoagulation during catheter-directed thrombolysis along with tissue plasminogen activator (Alteplase® ) for the treatment of a near-occlusive organ-threatening thrombus. We also review the currently available literature on the use of combination therapy of an intravenous direct thrombin inhibitor with alteplase.

Keywords: anticoagulation therapy; coagulation; intensive care; thrombolytic; thrombosis.

Publication types

  • Case Reports

MeSH terms

  • Antithrombins / therapeutic use*
  • Catheterization / adverse effects*
  • Child, Preschool
  • Drug Resistance / drug effects*
  • Fibrinolytic Agents / adverse effects
  • Heparin / adverse effects*
  • Hirudins
  • Humans
  • Male
  • Peptide Fragments / therapeutic use*
  • Prognosis
  • Recombinant Proteins / therapeutic use
  • Thrombolytic Therapy
  • Thrombosis / drug therapy*
  • Thrombosis / pathology
  • Tissue Plasminogen Activator / adverse effects*

Substances

  • Antithrombins
  • Fibrinolytic Agents
  • Hirudins
  • Peptide Fragments
  • Recombinant Proteins
  • Heparin
  • Tissue Plasminogen Activator
  • bivalirudin