bivalirudin / Generic mfg. - LARVOL DELTA

Comparison of bivalirudin versus heparin in percutaneous coronary intervention for patients with acute coronary syndrome: A meta-analysis. (PubMed, Medicine (Baltimore)) - "This meta-analysis suggests that bivalirudin may offer advantages over heparin in reducing in-hospital and 30-day mortality and major bleeding in patients with ACS undergoing PCI, with no significant differences in ischemic outcomes such as MACEs, MI, ST, or stroke. These findings suggest that bivalirudin may be a reasonable alternative to heparin in selected patients, but more large-scale, long-term RCTs are needed to confirm these results."

Clinical • Journal • Retrospective data • Acute Coronary Syndrome • Cardiovascular • Hematological Disorders • Myocardial Infarction • Thrombosis

Clinical outcomes of bivalirudin and heparin in pediatric extracorporeal membrane oxygenation: A systematic review and meta-analysis. (PubMed, Int J Artif Organs) - "Although ECMO duration was longer with bivalirudin (SMD 0.43, 95% CI 0.11-0.75), no significant differences were observed in circuit thrombosis, on-ECMO mortality, or time within the therapeutic range. Consequently, bivalirudin may provide a safer, more effective anticoagulation strategy than UFH in pediatric ECMO, though prospective multicenter studies and randomized trials are warranted to validate these findings."

Clinical data • Journal • Retrospective data • Review • Cardiovascular • Hematological Disorders • Pediatrics • Thrombosis

Real-world outcomes of unfractionated heparin plus antithrombin concentrate versus bivalirudin in adult patients undergoing extracorporeal membrane oxygenation. (PubMed, J Extra Corpor Technol) - "Antithrombin + UFH may be a preferable option for managing ECMO patients, particularly those with heparin resistance."

Clinical • Journal • Real-world evidence • Retrospective data • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Management of Heparin-Induced Thrombocytopenia With Plasmapheresis and IVIG Prior to Heart Transplantation: A Case Report. (PubMed, J Pharm Pract) - "Confirmed HIT led to switching anticoagulation to bivalirudin... This case demonstrates that combined PLEX and IVIG can effectively lower pathogenic HIT antibodies, permitting necessary heparin administration in critical settings like heart transplantation. Given the lack of standardized guidelines for managing HIT when heparin exposure is unavoidable, this report highlights a promising strategy to mitigate risks and underscores the need for further research to optimize care in such complex clinical scenarios."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • Hematological Disorders • Thrombocytopenia • Transplantation

Bivalirudin Demonstrates Favorable Safety Signals Compared With Heparin In Impella 5.5 Support (HFSA 2026) - "In this multicenter cohort, bivalirudin was associated with a favorable safety profile compared to heparin. Despite longer treatment duration, major bleeding and thrombotic events were similar. These findings support bivalirudin as a viable and potentially safer anticoagulation strategy for Impella 5.5 support and highlight the need for prospective evaluation."

Clinical • Hematological Disorders • Thrombocytopenia

Bivalirudin versus Heparin in Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation: A Multicenter Propensity-Matched Analysis (AHA 2026) - "Abstract is embargoed at this time."

Clinical • Cardiovascular

Low molecular weight heparin for AMI with frailty: short-Term outcomes after early PCI (ESC 2026) - "Patients were stratified into the LMWH group and control group (no LMWH, fondaparinux, or bivalirudin). In frail patients with AMI undergoing early PCI, the use of low molecular weight heparin demonstrates benefits in short-term cardiovascular, cerebrovascular and net adverse clinical events."

Cardiovascular • Coronary Artery Disease • Ischemic stroke • Myocardial Infarction

Bivalirudin versus heparin in high and low bleeding risk patients undergoing primary PCI for STEMI: pre-specified analysis from the BRIGHT-4 trial (ESC 2026) - "Among these patients, procedural anticoagulation with bivalirudin plus a high-dose post-PCI infusion for 2-4 hours reduced the 30-day primary composite outcome and all-cause death compared with heparin monotherapy at least as strongly in non-HBR patients as in HBR patients."

Clinical • Cardiovascular • Myocardial Infarction

Prognostic impact of post-procedural low-molecular-weight heparin in high-bleeding risk patients undergoing pci for acute myocardial infarction (ESC 2026) - "Key exclusion criteria included malignancy, specific high-risk arrhythmias (ventricular tachycardia/fibrillation, sinus arrest), Killip class III-IV, use of alternative anticoagulants (bivalirudin, fondaparinux), or oral anticoagulants.The primary endpoint was 30-day all-cause mortality. In this real-world cohort of AMI patients with HBR undergoing PCI, the use of post-procedural LMWH was associated with a significantly lower risk of 30-day all-cause mortality without a significant increase in major bleeding events. These findings suggest a favorable net clinical benefit for LMWH in this high-risk population, warranting further validation in prospective randomized trials."

Clinical • Cardiovascular • Myocardial Infarction • Ventricular Tachycardia

Bivalirudin Versus Heparin in Low and Non-Low Bleeding Risk Patients Undergoing Primary PCI for STEMI: The BRIGHT-4 Trial. (PubMed, J Am Coll Cardiol) - P=N/A | "Among patients with STEMI undergoing primary PCI with radial artery access, procedural anticoagulation with bivalirudin plus a high-dose post-PCI infusion for 2 to 4 hours reduced the 30-day risk of all-cause death and major bleeding in patients at low bleeding risk as well as in patients at higher-risk of bleeding. (Bivalirudin With Prolonged Full Dose Infusion Versus Heparin Alone During Emergency PCI [BRIGHT-4; NCT03822975])."

Journal • Cardiovascular • Myocardial Infarction

Bivalirudin in Primary PCI: Time to Implement the Overwhelming Evidence? (PubMed, J Am Coll Cardiol) - No abstract available

Journal • Acute Coronary Syndrome • Cardiovascular

POPS or POP02: Pharmacokinetics, Pharmacodynamics, and Safety Profile of Understudied Drugs Administered to Children Per Standard of Care (POPS) (clinicaltrials.gov) - P=N/A | N=5000 | Recruiting | Sponsor: Duke University | Trial completion date: Jul 2027 ➔ Dec 2026 | Trial primary completion date: Mar 2027 ➔ Nov 2026

Trial completion date • Trial primary completion date • ADHD (Impulsive Aggression) • Asthma • Attention Deficit Hyperactivity Disorder • Bronchopulmonary Dysplasia • Cardiovascular • CNS Disorders • Dermatology • Developmental Disorders • Endocrine Disorders • Genetic Disorders • Gynecology • Heart Failure • Hematological Disorders • Hemophilia • Hypertension • Immunology • Infectious Disease • Insomnia • Metabolic Disorders • Nephrology • Novel Coronavirus Disease • Pain • Pneumonia • Psychiatry • Pulmonary Arterial Hypertension • Pulmonary Disease • Rare Diseases • Renal Disease • Respiratory Diseases • Sleep Disorder

Anticoagulation management during low flow states in pediatric bivalirudin extracorporeal membrane oxygenation. (PubMed, Front Pediatr) - "UFH boluses during low-flow states in pediatric ECMO with bivalirudin anticoagulation are safe, without increased bleeding, circuit deposit burden requiring circuit interventions, or stroke. Prospective multicenter studies are needed to compare this approach to other anticoagulation strategies during low-flow and clamp trials, including UFH alone and bivalirudin without adjunctive UFH, and to further define their optimal dosing and safety profiles."

Journal • Cardiovascular • Ischemic stroke • Pediatrics

When Therapeutic Anticoagulation Fails: Refractory Portal and Mesenteric Venous Thrombosis of Unclear Origin Complicated by Bowel Perforation (ASA 2026) - "Despite therapeutic enoxaparin, he repeatedly failed to achieve or maintain therapeutic anticoagulation levels, concerning for anticoagulant resistance. Postoperative imaging showed persistent SMV branch thrombosis. Given ongoing surgical needs and inability to achieve adequate anticoagulation, he was managed with a perioperative bivalirudin infusion."

Cardiovascular • Hematological Disorders • Thrombosis

Assessment of Thrombin Generation in Pediatric Patients on Extracorporeal Life Support: Impact of Bivalirudin and Other Anticoagulants. (PubMed, Int J Lab Hematol) - "TGA shows promise in evaluating bivalirudin anticoagulation and is capable of detecting anticoagulant activity across both subtherapeutic and therapeutic levels of other agents commonly used in pediatric patients."

Journal • Pediatrics

Bivalirudin: A Viable Alternative to Heparin for Treatment of Venous Thrombosis in Children? (PubMed, Pediatr Crit Care Med) - No abstract available

Journal • Cardiovascular • Hematological Disorders • Thrombosis • Venous Thromboembolism

Safety of Bivalirudin Use in Critically Ill Children: A Single-Center Experience. (PubMed, Pediatr Crit Care Med) - "Bivalirudin, used in the setting of venous and/or arterial thromboses, rapidly achieves therapeutic levels. While use of bivalirudin is safe, clinically relevant bleeding and thrombotic rates on bivalirudin were frequent despite therapeutic ranges. These data highlight that bivalirudin use warrants close monitoring in critically ill children."

Journal • Cardiovascular • Hematological Disorders • Pediatrics • Thrombocytopenia • Thrombosis • Venous Thromboembolism

Massive aortic thrombus in a hypercoagulable patient with heparin induced thrombocytopenia: a case report. (PubMed, J Surg Case Rep) - "Following stabilization of acute HIT with argatroban, surgical thrombectomy of the large aortic thrombus and endarterectomy of a penetrating aortic ulcer was successfully performed using bivalirudin anticoagulation for cardiopulmonary bypass without complication. Postoperatively the patient was maintained on argatroban followed by transition to outpatient warfarin without new thromboembolic or bleeding complications."

Journal • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Successful atrial fibrillation ablation using bivalirudin in a patient with congenital factor XII deficiency and uninterpretable activated clotting time. (PubMed, HeartRhythm Case Rep) - No abstract available

Journal • Atrial Fibrillation • Cardiovascular

Between A Rock And A Hard Place: Balancing Anticoagulation And DAPT While Bleeding On ECMO With A New DES (ASA 2026) - "On POD#2 he developed severe thrombocytopenia with concern for HIT and subsequent diffuse pulmonary hemorrhage. A balance of thrombosis and hemorrhage prevention was attempted with treatments including intermittent heparin and bivalirudin infusions, DAPT, changing of ECLS strategies between VA to VV to V-AV ECMO as needed, inhaled TXA, and cryo-bronchoscopy."

Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Cardiogenic Shock Requiring Urgent LVAD with Concomitant Development of Heparin Induced Thrombocytopenia: A Case of Alprostadil Use (ASA 2026) - "Anesthesia intensivist transitioned anticoagulation to bivalirudin and three plasma exchange sessions were completed to reduce HIT antibodies with monitoring. Intraoperatively, alprostadil was initiated and discontinued following protamine administration with subsequent improvement in vasoplegia. He received two units of platelets and two units of fresh frozen plasma prior to ICU transfer."

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure • Hematological Disorders • Thrombocytopenia

Bivalirudin for CPB in the setting of HIT (ASA 2026) - "Valve repair was successful but complicated postoperatively by significant coagulopathy (INR >13), open chest, right frontoparietal subdural hematoma, refractory seizures requiring multi-modal management, and prolonged ICU course. Bivalirudin's renal clearance presented a challenge given ESRD; no reversal agent was available for bleeding; the frozen mediastinum (third sternotomy) and gummy, friable annular tissue dramatically increased hemorrhagic risk; quoted operative mortality was 75-90%."

Cardiovascular • Chronic Kidney Disease • CNS Disorders • Epilepsy • Hematological Disorders • Renal Disease • Thrombocytopenia

Liver Transplantation in a Patient with Polycythemia Vera, Budd-Chiari, and Heparin-Induced Thrombocytopenia (ASA 2026) - "The traditional approach to coagulopathy management was modified, and case performed on therapeutic warfarin (INR: 2.4), pro-thombotic products minimized, and bivalirudin initiated after portal vein thrombosis with one FFP product. This case highlights important considerations for complex cases of coagulopathy."

Clinical • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Focal Segmental Glomerulosclerosis • Genetic Disorders • Glomerulonephritis • Hematological Disorders • Hepatology • Hypertension • Liver Failure • Obesity • Polycythemia Vera • Renal Disease • Thrombocytopenia • Thrombosis • Transplantation • JAK2

Beef with Bypass: Alpha-Gal Syndrome in Cardiac Surgery (ASA 2026) - "Bivalirudin was used for systemic anticoagulation, citrate in the cell salvage, blood from bypass was ultrafiltrated prior to being returned and mechanical valve was placed. We describe an unusual case of patient with Alpha gal syndrome and its implications in cardiac surgery."

Surgery • Cardiovascular • Chronic Obstructive Pulmonary Disease • CNS Disorders • Epilepsy • Immunology • Respiratory Diseases • Urticaria

Alprostadil as a Therapeutic Agent for Managing Heparin-Induced Thrombocytopenia in Cardiac Surgery (ASA 2026) - "Given the need for CABG with active HIT being treated with bivalirudin, the patient was transferred from an outside hospital...Significant vasoplegia, likely due to the alprostadil, infusion required further vasopressors including vasopressin, dopamine, phenylephrine, and angiotensin. Neither increased clot burden nor increased bleeding was seen during the case."

Surgery • Cardiovascular • Hematological Disorders • Thrombocytopenia