PMC7516194_01
Bivalirudin dosing and relevant ACT in the present patient with HIT. (A) The dosage of bivalirudin and the ACT monitoring during bivalirudin treatment. Red squares indicate ACT values while the blue dos indicate bivalirudin doses. (B) The linear relationship between bivalirudin dosage and ACT value undergoing ECMO with CRRT. (C) The linear relationship between bivalirudin dosage and ACT value undergoing ECMO without CRRT. HIT, heparin-induced thrombocytopenia; ECMO, extracorporeal membrane oxygenation; CRRT, continuous renal replacement therapies; ACT, activated clotting times. y (dependent variable): ACT(s), x (independent variable): dosage of bivalirudin (mg/kg/hour).
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The average dose of bivalirudin used was 0.005-0.03 mg/kg/h with continuous renal replacement therapies (CRRT) and 0.03-0.15 mg/kg/h without CRRT ( Figure 1A ). Target ACT (200-250 s) and APTT (40-60 s) were managed easily with bivalirudin and no supplemental boluses were needed ( Figure 1A ).
Platelet counts in the present patient with HIT are displayed during ECMO support with heparin therapy and bivalirudin anticoagulation, respectively. The red squares indicate platelet counts (*109/L). HIT, heparin-induced thrombocytopenia; ECMO, extracorporeal membrane oxygenation.
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The platelet counts gradually increased and remained stable (70-90 x109/L) throughout the infusion of bivalirudin ( Figure 2 ).