Bivalirudin dosing for cardiac surgery

	Bolus dosing	Infusion dosing*	Considerations
On pump	1 mg/kg	2.5 mg/kg/hour	50 mg added to CPB prime
Off pump	0.75 mg/kg	1.75 mg/kg/hour	If converting to CPB, an additional 0.25 mg/kg bolus is warranted with an increase in the infusion rate to 2.5 mg/kg/hour

ACT values are not used to monitor the degree of anticoagulation during CPB. ACT values do not have a linear relationship with bivalirudin concentrations (in contrast to ecarin clotting time [ECT], which is rarely available). A doubling of baseline ACT is evidence that bivalirudin has circulated and is having an effect. The bolus and infusion dosing guidelines in the table are empiric.

ACT: activated whole blood clotting time; CPB: cardiopulmonary bypass.
* If renal impairment, infusion dosing should be adjusted to maintain target ACT. Bolus dosing remains unchanged.

Graphic 108174 Version 3.0

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Bivalirudin dosing for cardiac surgery