Adjunct bivalirudin dosing protocol for neuro-endovascular procedures.

OBJECTIVE To introduce a protocol for anticoagulation using bivalirudin in neuro-endovascular procedures. METHODS Three different bivalirudin dosing protocols were used in four consecutive patients undergoing neuro-endovascular procedures. Activated clotting time (ACT) was closely monitored to assess the effect of bivalirudin on ACT. Target ACT was set at 300-350 seconds. RESULTS The first dosing protocol led to largely supra-therapeutic ACT values. With the second protocol, ACT remained sub-therapeutic for 25 minutes (33% of monitoring time). The third protocol was applied to two patients and it showed the best results with the ACT being in the therapeutic range for 72% of the combined monitoring time and never exceeding 366 seconds. CONCLUSIONS The dosing of bivalirudin needs to be adjusted for the use in neuro-endovascular procedures. We are proposing a protocol that seems to provide safe and effective anticoagulation. The safety and efficacy of bivalirudin in neuroendovascular procedures will need to be further validated in future studies.