Bivalirudin For The Treatment Of Hit A Miscellaneous Studies

Data on the use of bivalirudin in the treatment of HIT is beginning to accumulate. Chamberlin et al. (1994) reported three patients who received bivalirudin for HIT. One patient was treated for 8 days due to bilateral lower extremity DVTs and recurrent PE with a positive heparin-induced platelet aggregation test, while the other two patients received bivalirudin for arterial ischemia due to HIT. One patient required an above-the-knee amputation and was given bivalirudin (for 12 days) to prevent loss of the other limb, while the other patient had worsening peripheral arterial disease and underwent angioplasty of his right superficial femoral artery using bivalirudin anticoagulation.

In another study, a total of 39 patients with HIT were treated with bivalir-udin (Berkowitz, 1999a; Campbell et al., 2000a; Gladwell, 2002). Seventeen patients had acute HIT, while 22 had previous HIT. Patients were treated for a variety of indications (Table 6). There were four deaths (10%), all due to complications from HIT. Revascularization was successful in all but one patient (94%) who had PCI. The one failure was attributed to an unapproachable lesion. Two of the patients required intra-aortic balloon pumps, while another two underwent successful coronary artery bypass surgery. Bleeding complications were usually minor.

More recently, Francis and colleagues (2004) presented their experience using bivalirudin to treat 52 patients with a clinical suspicion of, or at an increased risk

TABLE 6 Indications for Bivalirudin Use in Patients with HIT

Indication

Number treated (%)

0 0

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