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Alternatives for Pediatric Anticoagulation

The Case for Bivalirudin

Nathan, Naveen, MD

doi: 10.1213/ANE.0000000000003940
Infographics: Infographic

Northwestern University Feinberg School of Medicine (

Published ahead of print 18 October 2018.

The Infographic is composed by Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The author declares no conflicts of interest.



In this infographic, we review the basic pharmacologic properties of bivalirudin, a divalent direct thrombin inhibitor for use as an alternative to heparin. It has been extensively studied as used for adult patients during cardiopulmonary bypass and cardiac catheter–based procedures. However, much less is known about its pharmacologic behavior in children. The authors of the cited review offer their recommendations on the use of bivalirudin in the pediatric population. *Note that the dosages listed in this infographic are based on limited data and extrapolations from adult pharmacology. For a full scope and understanding of the use of bivalirudin, particularly during cardiopulmonary bypass, the reader is strongly encouraged to review the referenced article.

ACT indicates activated clotting time; aPTT, activated partial thromboplastin time; AT, antithrombin; CPB, cardiopulmonary bypass; INR, international normalized ratio; PK/PD, pharmacokinetic and pharmacodynamic; PT, prothrombin time; TT, thrombin time.

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1. Zaleski KL, DiNardo JA, Nasr VG. Bivalirudin for pediatric procedural anticoagulation: a narrative review. Anesth Analg. 2019;128:4355.
    © 2019 International Anesthesia Research Society