ROTEM and Bivalirudin: The Confounding Challenges Ahead

Direct thrombin inhibitors directly bind to active sites on thrombin and exert their anticoagulant effect. Bivalirudin is used an alternative in cases of heparin-induced thrombocytopenia, heparin resistance, anaphylactic reaction to UFH, or anti-thrombin III deficiency. Here, we report a case of a 31-year-old female patient, diagnosed with recurrent chronic thromboembolic pulmonary hypertension posted for redo pulmonary thromboendarterectomy. Monitoring anticoagulation during bivalirudin therapy is sometimes confounding and challenging. Prolongation of CT on INTEM and HEPTEM has shown moderate to strong correlation with traditional laboratory tests like aPTT and HPTT (aPTT with Hepzyme). ROTEM can be a way forward for monitoring bivalirudin therapy.