There is no specific antagonist to bivalirudin. If renal function is normal, bivali-rudin is eliminated rapidly, and its anticoagulant effect clears within a few hours after discontinuing the infusion. Kaplan and Francis (2002) have suggested that recombinant factor VIla and desmopressin may be of benefit if bleeding occurs. Approximately 25% of bivalirudin can be removed by hemodialysis (Irvin et al., 1999; The Medicines Company, 2005).

Koster and colleagues (2003b) demonstrated that large amounts of bivali-rudin can be removed by hemofiltration and plasmapheresis. They utilized five different hemofilters in an in vitro study (conditions mimicking CPB) and observed a correlation between pore size and elimination rate. In their study, 65% of bivalirudin was removed using a hemofilter with a large pore size (65,000 Da) (Mintech Hemocor HPH 700, Minneapolis, MN, USA), an amount comparable to that eliminated with a plasmapheresis filter system (69%). This represents a 50% improvement over the amount of lepirudin that can be removed through filtration (moreover, lepirudin filtration correlates poorly with pore size). These authors suggest that hemofiltration using appropriate filters may be useful for routine management of patients who receive bivalirudin for cardiac surgery.

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