Bivalirudin, Ecarin, Plasma
Use
This test is useful for monitoring bivalirudin therapy in patients who have prolonged baseline activated partial thromboplastin time. Bivalirudin, a parenteral anticoagulant, directly inhibits thrombin (factor IIa) and is administered via continuous intravenous infusion. It is indicated for patients with unstable angina undergoing percutaneous coronary intervention (PCI), provisional use of glycoprotein IIb/IIIa inhibitor, or with heparin-induced thrombocytopenia (HIT) undergoing PCI, often used along with aspirin. Monitoring is crucial in instances of prolonged baseline aPTT due to lupus anticoagulants or factor XII deficiency.
Special Instructions
This test should not be used for monitoring low molecular weight heparin, unfractionated heparin, or oral direct anti-Xa inhibitors such as apixaban or rivaroxaban. Each coagulation assay requested should have its own vial. The specimen must be double-centrifuged to avoid platelet contamination that could lead to erroneous results. For complete instructions, see Mayo Clinic's Coagulation Guidelines for Specimen Handling and Processing. If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.
Limitations
Bivalirudin concentration may be affected by drug interactions, liver, and kidney disease. Significant hemolysis or bilirubin in the sample could decrease bivalirudin levels, while lipemia might cause an increase. Routine monitoring of bivalirudin drug levels is typically not indicated according to product guidelines, which recommend using the activated partial thromboplastin time ratio instead. Bivalirudin drug concentrations and their correlation with aPTT ratios can vary with different aPTT reagents, which should be taken into account when interpreting results.
New York Approved
Methodology
Immunoassay (Chromogenic)
Biomarkers
LOINC Codes
- 104690-3
- 104690-3
- 69049-5
- 62364-5
Result Turnaround Time
1-3 days
Related Documents
For more information, please review the documents below
Specimen
Plasma
Volume
1 mL
Minimum Volume
0.5 mL
Container
Light-blue top (3.2% sodium citrate) tube; submission in a plastic vial (polypropylene preferred)
Collection Instructions
Collect specimen 2 hours after the start of continuous infusion of bivalirudin. Centrifuge, transfer plasma, centrifuge again, then aliquot plasma leaving 0.25 mL in the vial. Freeze immediately at -20°C or ideally below -40°C.
Causes for Rejection
Thawed specimens; cold or warm rejection
Stability Requirements
| Temperature | Period |
|---|---|
| Frozen | 42 days |