(1445) Bivalirudin Safety and Effectiveness in Patients on Continuous Renal Replacement Therapy

Introduction: Bivalirudin is a continuous infusion direct thrombin inhibitor (DTI) which requires dose adjustments for patients with renal impairment. In 2019, our institution developed a new bivalirudin protocol which initiates patients on continuous renal replacement therapy (CRRT) at a rate of 0.08 mg/kg/hr. The primary objective of this study was to evaluate the safety of bivalirudin in patients with normal renal function versus patients on CRRT.

Methods: This was a retrospective, single-centered, observational study at a large academic medical center comparing patients who received bivalirudin with a creatinine clearance (CrCl ≥60 mL/min) and patients who were on CRRT. Included subjects were 18 years or older and had received bivalirudin for greater than 24 hours between September 1, 2019 to December 1, 2023. Subjects were excluded if they were on other forms of renal replacement therapy than CRRT, had a baseline aPTT greater than 36.0 seconds, received argatroban during the same admission, if the indication for bivalirudin was for heparin resistance, received bivalirudin in the catheterization lab or operating room, or if the institutional bivalirudin protocol was not utilized.

Results: A total of 143 patients were included in the primary outcome analysis, with 123 patients in the normal renal function group, Crcl ≥60 ml/min, and 20 in the CRRT group. Baseline characteristics across both groups were similar. At baseline, platelet count at the time of initiation of bivalirudin was lower in the normal renal function group compared to the CRRT group (126 k/cumm vs 56 k/cumm, p < 0.01). There was no significant difference in the primary outcome of major bleeding events between in the normal renal function group compared to the CRRT group (32.5% vs. 35%, p= 0.8). The only secondary outcome with a difference was mortality, with 13% of normal renal function group dying vs. 40% in the CRRT group (p < 0.01).

Conclusions: There was no difference in major bleeding events in patients who received continuous infuse bivalirudin with normal renal function compared to those on CRRT.