To date bivalirudin is the only alternative anticoagulant being assessed in prospective trials for intraoperative anticoagulation during cardiac surgery. Based on the currently available data, bivalirudin can be recommended as a first-line option in HIT patients undergoing OPCAB surgery. It also is the drug-of-choice in a large variety of procedures in cardiac surgery requiring CPB, at least where experience exists in adjusting surgical and perfusion techniques to reflect the unique pharmacology of the agent (Table 3).

As there are no data regarding use of bivalirudin for vascular surgery, no recommendations can be given, and some general skepticism regarding feasibility of bivalirudin in this indication is warranted.

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