ArticleFrontiers in cardiovascular medicine2026
Bivalirudin as rescue therapy for suspected heparin resistance and recurrent intra-procedural stent thrombosis during complex percutaneous coronary intervention: a case report.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Heparin resistance (HR) poses a significant challenge during percutaneous coronary intervention (PCI), potentially leading to catastrophic thrombotic complications. Here, we report a case of suspected refractory HR and recurrent intra-stent thrombosis during a complex PCI for a heavily calcified lesion, despite aggressive antiplatelet therapy and glycoprotein IIb/IIIa inhibition. Subtherapeutic anticoagulation persisted despite repeated unfractionated heparin boluses [cumulative dose 11,000 U; activated clotting time (ACT) 132 s]. Switching anticoagulation to the direct thrombin inhibitor bivalirudin resulted in rapid achievement of therapeutic anticoagulation (ACT 320 s within 10 min) and marked reduction in thrombus burden. This case highlights bivalirudin as an effective rescue strategy for managing HR and preventing thrombosis progression in complex PCI settings, emphasizing the need for timely recognition and alternative anticoagulation in such high-risk scenarios.
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