Q: 54 year old male with ESRD (End Stage Renal Disease) on hemodialysis (HD) - who developed HIT (Heparin Induced Thrombocytopenia) while in ICU and on bivalirudin now - need placement of new dialysis catheter. What caution should be taken while holding bivalirudin before procedure?

Answer: 

Bivalirudin is cleared from plasma by a combination of both renal mechanism and proteolytic cleavage. Half-life of bivalirudin with normal renal function is 25 minutes but in patients with ERSD who are HD dependent may go up to 3.5 hours. So caution should be taken while performing procedures.