Successful use of bivalirudin in neonates for postoperative aortopulmonary shunt thrombosis prevention.

OBJECTIVES

We aim to describe the successful use of bivalirudin for immediate postoperative aortopulmonary shunt thrombosis prevention. This article also describes the details of an institutional protocol for postoperative aortopulmonary shunt thrombosis prevention. In addition, we demonstrate the safe and effective use of low-molecular-weight heparin and aspirin for interstage thrombosis prevention.

METHODS

Retrospective cohort study of neonates (excluding infants younger than age 1 day and older than age 28 days) undergoing stage 1 single-ventricle palliation with either a modified Blalock Taussig Thomas or central shunt over a 2-year period.

RESULTS

Eighteen consecutive neonates were studied, 11 patients after modified Blalock Taussig Thomas shunt and 7 after central shunt. All patients were initiated on bivalirudin infusion of 0.2 mg/kg/h. Patients remained within the target partial thromboplastin time range of 50 to 70 seconds a median of 97% of the time. None of the 18 patients had shunt thrombosis during the first 21 days after surgery. There were 2 patients who experienced late shunt thrombosis (61 and 27 days), prompting the addition of low-molecular-weight heparin to aspirin after transition from bivalirudin. With low-molecular-weight heparin and aspirin, there were no further shunt thromboses and all patients survived to second-stage surgery.

CONCLUSIONS

Bivalirudin is a safe and effective alternative to unfractionated heparin for immediate postoperative aortopulmonary shunt thrombosis prevention. Transition to low-molecular-weight heparin and aspirin resulted in effective and safe thrombosis prevention through the second-stage surgery. This regimen resulted in no bleeding complications in this cohort of 18 infants.