bivalirudin / Generic mfg. - LARVOL DELTA

Alternate and Emerging Anticoagulation Strategies for Extracorporeal Membrane Oxygenation: A Scoping Review. (PubMed, J Clin Med) - "Other agents, including nafamostat mesylate, prostaglandin E1, and factor pathway inhibitors remain early in clinical investigation... ECMO anticoagulation is transitioning from UFH reliance toward diversified and personalized strategies. Future research should prioritize multicenter randomized controlled trials, standardize protocols, expand to neonatal and pediatric investigation, and integrate strategies."

Journal • Review • Hematological Disorders • Pediatrics • Thrombocytopenia

Dilute Thrombin Time to Monitor Bivalirudin in Pediatric Extracorporeal Membrane Oxygenation-Progress Does Not Always Have to Cost More. (PubMed, Pediatr Crit Care Med) - No abstract available

Journal • Pediatrics

ANTICOAGULANT - ASSOCIATED ACUTE KIDNEY INJURY: A PHARMACOVIGILANCE ANALYSIS BASED ON FDA ADVERSE EVENT REPORTING SYSTEM (ISN-WCN 2026) - "A).Warfarin had stable low reports, while newer oral anticoagulants (NOACs) showed dramatic trends: Apixaban peaked over 20,000 around 2021, Rivaroxaban near 20,000 in 2015, Dabigatran over 11,000 in 2012. Drugs like Argatroban, Bivalirudin, and Dalteparin had consistently low reports (Fig...Results show heterogeneity in renal ADRs; Fondaparinux and Apixaban signal specific toxicities. Findings can guide pharmacovigilance and clinical decisions for renal risk patients."

Adverse events • Acute Kidney Injury • Nephrology • Renal Disease • ROR1

Anticoagulation management and monitoring in ECMO: an international survey: communication from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis. (PubMed, Res Pract Thromb Haemost) - "Both unfractionated heparin and bivalirudin were reported to be used routinely for anticoagulation at 92.2% and 52.9%, respectively...Most centers utilize protocols for management, yet wide variability in ECMO management was again highlighted. Continued prospective and collaborative research efforts are needed to make advancements in treatment and outcomes, and to help streamline the care of this complex patient population."

Journal • Cardiovascular • Hematological Disorders • Pediatrics • Thrombosis

Comparing Safety and Efficacy Between Regional Citrate, Unfractionated Heparin, and Bivalirudin in Pediatric Continuous Kidney Replacement Therapy (PAS 2026) - No abstract available

Clinical • Pediatrics

Surviving the Burn: Anticoagulation Strategies for VV ECMO in Complex Thermal Injury (SCCM 2026) - "He was initially started on heparin and transitioned to bivalirudin due to heparin resistance...These cases suggest ECMO is safe with individualized risk assessment. More study is needed to establish best practice for anticoagulation and perioperative management in burn patients on ECMO."

Cardiovascular • Hematological Disorders • Thermal Injury • Thrombocytopenia • Thrombosis

Anticoagulation With Bivalirudin vs Heparin Post Left Ventricular Assist Device Implantation (SCCM 2026) - "Similar rates of bleeding and thromboembolic events were observed comparing bivalirudin and heparin in the immediate postoperative period following LVAD implantation."

Cardiovascular • Hematological Disorders • Thrombosis

Practice Variation in Anticoagulation With Direct Thrombin Inhibitors During ECMO (SCCM 2026) - "A 2019 survey of ECMO medical directors reported only 6% of pediatric ECMO centers used bivalirudin as a primary anticoagulant... There is a notable increase in the use of DTIs in ECMO. However, significant practice variation exists across centers."

Pediatrics

Effect of Cystatin C on Initial Bivalirudin Dose Selection in Acutely Ill Patients (SCCM 2026) - "Routine use of cystatin C-based eGFR would lead to selection of lower initial bivalirudin doses than traditional creatinine-based dosing methods."

Clinical • Cardiovascular • Chronic Kidney Disease • Venous Thromboembolism • CST3

Effects of Nitric Oxide in Sweep Gas in Pediatric ECMO: A Descriptive Review (SCCM 2026) - "When used in conjunction with therapeutic bivalirudin, NO was also associated with fewer fresh-frozen plasma transfusions, without clinically significant methemoglobinemia or differences in adverse bleeding events... The available evidence suggests that the addition of NO to the sweep gas in pediatric ECMO plays a role in mitigating thrombosis and inflammation, without increasing the risk of bleeding or methemoglobinemia. However, multicenter prospective studies and/or randomized controlled trials are needed to establish safety, efficacy, and accurate treatment guidelines."

Clinical • Review • Cardiovascular • Hematological Disorders • Inflammation • Pediatrics • Respiratory Diseases • Thrombosis

Factor IIa Inhibitors: Mechanisms, Clinical Complications, and Advances in Reversal Strategies (THSNA 2026) - "Direct thrombin inhibitors, such as dabigatran, argatroban, and bivalirudin, provide targeted anticoagulation across a wide range of cardiovascular and hematologic settings...Special focus was placed on specific reversal agents such as idarucizumab, the use of four-factor prothrombin complex concentrates, and investigational options such as Ciraparantag...Idarucizumab, a monoclonal antibody fragment with strong binding affinity for dabigatran, is the only United States Food and Drug Administration-approved reversal agent for any direct thrombin inhibitor and rapidly restores clotting parameters...Continued clinical research will determine its safety, efficacy, and overall impact on the future of anticoagulation management. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author."

Clinical • Atrial Fibrillation • Cardiovascular • Hematological Disorders • Thrombocytopenia • Venous Thromboembolism

Comprehensive Evaluation of HIT Outcomes: Ongoing Thrombotic Complications Despite Standard Therapy (THSNA 2026) - "Among these patients, 27 (73%) were treated with Argatroban, 6 (16%) with bivalirudin, 1 (2.7%) with fondaparinux, and 2 (5.4%) with apixaban. HIT remains a highly morbid and life-threatening condition, with prolonged hospitalizations, high rates of both thrombotic and bleeding complications, and substantial ICU utilization. Thrombotic events occurred even among patients who were promptly treated, highlighting the persistent risk despite appropriate management. Further studies are needed to better identify which patients are at highest risk for severe complications."

Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

The Sentinel Role of the Pathologist in Distinguishing Bivalirudin Overdosing from Contamination in Pediatric Patients on ECLS (THSNA 2026) - "Accidental overdosing can occur in specimens showing extreme coagulation values in pediatric ECLS patients anticoagulated with bivalirudin. Direct measurement of bivalirudin concentration is essential for clinical laboratories to monitor anticoagulation levels and detect potential overdose. In cases where overdose is clinically suspected, it is critical to stop the drug infusion to minimize bleeding risk."

Clinical • Pediatrics

Implementation and Outcomes of a Pharmacist-Driven Protocol for Direct Thrombin Inhibitor Titration in Patients with Heparin-Induced Thrombocytopenia (THSNA 2026) - "Pharmacists are frequently delegated authority for management of other anticoagulants such as heparin and warfarin, with successful outcomes... Prior to implementation of the protocol, 53 orders for argatroban or bivalirudin for suspected or confirmed HIT were identified between December 2023 and April 2025... We anticipate that the transition to a pharmacist-led titration protocol will decrease the time to achieve goal PTT, improve adherence to the institution's internal DTI titration guideline, and decrease the frequency of DTI-related bleeding events and other events reported to the institution's safety event reporting tool. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author."

Clinical • Hematological Disorders • Thrombocytopenia

A single-center analysis of bivalirudin infusion rates in pediatric patients requiring systemic anticoagulation for treatment or prevention of thrombosis. (THSNA 2026) - "Based on this study we propose starting bivalirudin rates of of 0.25 mg/kg/hr and 0.45 for pediatric patients ≥ 1 year old and <1 year old, respectively. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author."

Clinical • Cardiovascular • Hematological Disorders • Nephrology • Pediatrics • Renal Disease • Thrombosis • Venous Thromboembolism

Bivalirudin Versus Heparin in Adults Requiring Venoarterial ECMO for Surgical Indications (SCCM 2026) - "In this cohort, bivalirudin did not significantly reduce thrombosis, bleeding, or transfusion needs compared to UFH. However, it achieved therapeutic levels faster and had a higher proportion of time in therapeutic range, suggesting more predictable anticoagulation in surgical VA-ECMO patients."

Clinical • Cardiovascular • Hematological Disorders • Thrombosis

EFFECT OF PROLONGED ANTICOAGULATION ON MYOCARDIAL INJURY AFTER PRIMARY PCI FOR STEMI: RIGHT CMR SUBSTUDY (ACC 2026) - "The secondary objective was to evaluate the effect of different anticoagulation regimen (bivalirudin, enoxaparin or unfractionated heparin) on infarct size. The CMR substudy of RIGHT trial demonstrated that prolonged anticoagulation after primary PCI for STEMI did not reduce infarct size."

Acute Coronary Syndrome • Cardiovascular • Coronary Artery Disease • Heart Failure • Reperfusion Injury

COMPARISON OF BIVALIRUDIN VERSUS HEPARIN IN PATIENTS WITH PERCUTANEOUS VENTRICULAR ASSIST DEVICE SUPPORT (ACC 2026) - "The results will be discussed."

Clinical • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

IMPELLA ASSOCIATED ENDOCARDITIS IN A TRANSPLANT CANDIDATE WITH ADVANCED HEART FAILURE (ACC 2026) - "Case: A 56-year-old man with HFrEF on home milrinone, Bi-Ventricular ICD, Atrial fibrillation, pulmonary hypertension, presented with acute decompensated heart failure and recent ICD shock...Bivalirudin was held due to the severe anemia, increasing device risk... Impella can be life-saving in advanced heart failure, but device-related endocarditis with septic shock underscores the extreme complexity of managing transplant candidates on MCS."

Metastases • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Hematological Disorders • Immunology • Infectious Disease • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Septic Shock • Transplantation

CHROMOGENIC FACTOR X VS INTERNATIONAL NORMALIZED RATIO MONITORING IN PATIENTS WITH HEPARIN-INDUCED THROMBOCYTOPENIA TRANSITIONED FROM BIVALIRUDIN TO WARFARIN (ACC 2026) - "This study will be the first to evaluate CFX- versus INR-guided monitoring in patients with HIT transitioned from bivalirudin to warfarin, providing information on strategies to minimize INR fluctuations and reduce the risk of bleeding from supratherapeutic INRs and thrombosis from subtherapeutic INRs."

Clinical • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

EFFICACY AND SAFETY OF ANTICOAGULATION WITH BIVALIRUDIN VERSUS UNFRACTIONATED HEPARIN IN PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) (ACC 2026) - "Data collection and analysis are ongoing. Results will be presented at ACC.26 during the scientific poster session."

Clinical

TRANSESOPHAGEAL ECHOCARDIOGRAPHY-GUIDED PERCUTANEOUS MECHANICAL ASPIRATION OF RIGHT ATRIAL THROMBUS FORMED DURING VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (ACC 2026) - "The course was further complicated by heparin-induced thrombocytopenia (HIT) necessitating transition from heparin to bivalirudin... To our knowledge, this is the first reported case of percutaneous mechanical aspiration of an RA thrombus associated with VA-ECMO cannulation, demonstrating its feasibility and therapeutic potential in complex critically ill patients."

Coronary Artery Disease • Hematological Disorders • Pulmonary Embolism • Thrombocytopenia • Thrombosis

COMPARING OUTCOMES BETWEEN HEPARIN AND BIVALIRUDIN USE IN CARDIOGENIC SHOCK PATIENTS ON LEFT VENTRICLE ASSIST DEVICES: A PROPENSITY-MATCHED REAL-WORLD STUDY (ACC 2026) - "There was no difference in thrombotic or bleeding risks in real world data comparing bivalirudin and heparin amongst CS patients supported on Impella® devices, however, rates of hemodialysis were lower with bivalirudin use."

Clinical • Real-world • Real-world evidence • Cardiovascular • Hematological Disorders • Renal Disease

BIVALIRUDIN VERSUS HEPARIN FOR ANTICOAGULATION IN ADULT ECMO: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS INCORPORATING SENSITIVITY ANALYSES, PUBLICATION BIAS ASSESSMENT, AND GRADE EVALUATION (ACC 2026) - "Bivalirudin is associated with reduced risks of mortality, major bleeding, and thrombosis compared to heparin among adult ECMO patients, with greatest benefit in veno-venous ECMO. Limitations include moderate risk of bias, heterogeneity in outcome definitions, and predominantly Western cohorts. Bivalirudin is a viable alternative anticoagulant for patients with heparin contraindications or anticipated prolonged ECMO."

Retrospective data • Review • Cardiovascular • Hematological Disorders • Respiratory Diseases • Thrombocytopenia • Thrombosis

HEPARIN VS BIVALIRUDIN IN AMI-CARDIOGENIC SHOCK SUPPORTED WITH PERCUTANEOUS LEFT VENTRICLE ASSIST DEVICES: A PROPENSITY-MATCHED REAL-WORLD STUDY (ACC 2026) - "There was no difference in thrombotic or bleeding risks in real world data comparing bivalirudin and heparin amongst AMI-CS patients supported on Impella® devices."

Clinical • Real-world • Real-world evidence • Cardiovascular • Hematological Disorders • Ischemic stroke