Bye-Bye-Bivalirudin

Document Type

Conference Proceeding

Publication Date

3-6-2026

Publication Title

Am J Health Syst Pharm

Keywords

Pharmacology & Pharmacy

Abstract

Purpose: Bivalirudin is a direct thrombin inhibitor most commonly used in patients with heparin-induced thrombocytopenia. Current practice at Henry Ford Hospital requires activated partial thromboplastin time (aPTT) monitoring at 2, 4, and ultimately 12-hour intervals for patients at their PTT goal on a stable dose. With predictable pharmacokinetics, patients often remain stable on unchanged bivalirudin dosing for extended time intervals. Monitoring PTT every 12 hours may be resource-intensive and unnecessary once the optimal bivalirudin dose is established and therapeutic goals are met. This evaluation will assess whether extended monitoring intervals beyond 12 hours can be safely adopted at our institution. Methods: This retrospective, single-center, medication use evaluation will include adult patients who received bivalirudin at Henry Ford Hospital between January 1st, 2019, and September 1st, 2025. Patients with at least three consecutive therapeutic PTTs on the same dose of bivalirudin will be included. Reasons for exclusion will include protected populations and patients on mechanical circulatory support devices. Data will be collected for up to 72 hours for patients on a stable bivalirudin therapy that does not necessitate any dose changes. A random sample of 100 patients in a 3:1 ratio of GPU:ICU level care will be assessed. The sample will be enriched with a minimum of 10 patients with severe CKD or requiring dialysis. Baseline demographic information will be collected, in addition to clinical, and laboratory data including comorbidities, renal function, concomitant antithrombotic therapies, weight-based dosing, coagulation lab values, aPTT values, and bivalirudin dosing during the index admission. Primary outcomes will include the average duration of therapeutic anticoagulation without dose adjustment. Secondary endpoints include the percentage of therapeutic aPTTs during q12h monitoring and the incidence of ISTH major bleeding. Categorical data will be described using simple frequencies and descriptive statistics for numerical data. Ordinal and continuous data will be described using measures of central tendency

Volume

83

First Page

S805

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