The Editors of AHFS Drug Information® (AHFS DI®) wish to inform you of an error in the bivalirudin monograph 20:12.04.12 that resulted from an error in one of the cited references, the American College of Chest Physicians (ACCP) guideline on treatment and prevention of heparin-induced thrombocytopenia (Warkentin TE, Greinacher A, Koster A et al. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians evidence‐based clinical practice guidelines (8th ed). Chest. 2008; 133 (Suppl):340S‐80S).

The error appears in the second column on page 1480 of the printed edition of AHFS DI 2011® under the subhead Heparin-induced Thrombocytopenia in Patients Undergoing Cardiac Surgery, in Dosage and Administration: Dosage. In the second sentence under this subhead, the statement should read:

“During cardiopulmonary bypass, an initial bivalirudin dosage of 1 mg/kg given by direct IV injection, followed by continuous IV infusion at a rate of 2.5 mg/kg per hour has been used; additional direct IV doses of 0.1–0.5 mg/kg have been given if needed to maintain a 2.5‐fold or greater prolongation of the baseline ACT.”

The originally stated dosage of 0.1–0.5 mg for additional direct IV doses of bivalirudin is incorrect and is based on a typographical error in Table 7 on page 369S of the ACCP clinical practice guideline article cited above. The correct dosage (0.1–0.5 mg/kg) is indicated by the following information on page 573‐ 574 of reference 226 (Koster A, Dyke CM, Aldea G et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the CHOOSE‐ON trial. Ann Thorac Surg. 2007; 83:572‐7) cited in Table 7 of the ACCP guideline article: “Anticoagulation was regarded as adequate if a 2.5‐fold or greater prolongation of the baseline value of the institutionally used activated clotting time (ACT) system was achieved. Additional boluses of 0.1–0.5 mg/kg [of bivalirudin] could be administered at the discretion of the treating team.” As noted, the drug is dosed according to response using coagulation assays (e.g., ACT).

The American College of Chest Physicians (ACCP) has been made aware of this error in its publication and is in the process of informing its readers.

See http://www.ahfsdruginformation.com for the revised AHFS monograph and Essentials monograph on bivalirudin.