Plasma Na Cit
This test measures bivalirudin only. For measurement of argatroban direct thrombin inhibitor, order ARGAT / Argatroban, Ecarin, Plasma. For measurement of dabigatran direct thrombin inhibitor, order DABIE / Dabigatran, Ecarin, Plasma.
This test is not indicated for monitoring low molecular weight heparin (LMWH), unfractionated heparin (UFH), or oral direct anti-Xa inhibitors (eg, apixaban, rivaroxaban, edoxaban). For monitoring oral direct anti-Xa inhibitors, see APIXA / Apixaban, Anti-Xa, Plasma; EDOXA / Edoxaban, Anti-Xa, Plasma, or RIVAR / Rivaroxaban, Anti-Xa, Plasma.
If priority specimen, mark request form, give reason, and request a call-back.
Supplies: Sarstedt 5 mL Aliquot Tube (T914)
Specimen Type: Platelet-poor plasma
Collection Container/Tube: Light-blue top (3.2% sodium citrate)
Submission Container/Tube: Plastic vial (polypropylene preferred)
Specimen Volume: 1 mL
1. Specimen should be collected 2 hours after initiation of continuous infusion of bivalirudin.
2. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing in Special Instructions.
3. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.
4. Aliquot plasma into a plastic vial leaving 0.25 mL in the bottom of centrifuged vial.
5. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C or, ideally, < or =-40 degrees C.
1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.
2. Each coagulation assay requested should have its own vial.
If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.
|Thawing||Cold Reject; Warm reject|
|Specimen Type||Temperature||Time||Special Container|
|Plasma Na Cit||Frozen (preferred)||42 days|
Bivalirudin, a parenteral anticoagulant that directly inhibits thrombin (direct thrombin inhibitor, DTI) factor IIa. It is indicated for use in patients with unstable angina undergoing percutaneous coronary intervention (PCI), in those undergoing PCI with provisional use of glycoprotein IIb/IIIa inhibitor (GPI), or in those with, or at risk of, heparin- induced thrombocytopenia (HIT) or HIT and thrombosis syndrome (HITTS) undergoing PCI. In these indications it is intended for use with aspirin.
Frequently, bivalirudin is used for prevention of treatment of thrombosis in patients with HIT with or without thrombosis and with renal and/or hepatic dysfunction.
Bivalirudin is administered via continuous intravenous infusion, is removed by a combination of proteolytic cleavage by thrombin and renal clearance mechanisms, and can inhibit both soluble and clot-bound thrombin.
Bivalirudin's effect is typically monitored using the activated partial thromboplastin time (aPTT) test with a target aPTT ratio of 1.5 to 2.5 times the patient’s baseline value. However, in instances where patients have a prolonged baseline aPTT (eg, lupus anticoagulants and factor XII deficiency), aPTT monitoring of bivalirudin is not reliable and direct measurement of the effect of bivalirudin on factor IIa may be more reliable. For HIT, monitoring every 2 to 4 hours until in range and then once daily; for PCI, monitoring is unnecessary unless renal failure is present.
Internal laboratory validation demonstrates that plasma concentrations of bivalirudin from 0.25 to 2.00 mcg/mL correspond to an aPTT ratio of 1.5 to 3.0. Correlation of bivalirudin drug concentrations with aPTT ratios may vary with different aPTT reagents.
The recommended monitoring per product guidelines is with the activated partial thromboplastin time ratio, routine monitoring of bivalirudin drug levels is not indicated.
Bivalirudin concentration may be affected by drug interactions, liver, and renal disease.
Marked presence of hemolysis or bilirubin in the sample could falsely decrease bivalirudin levels. Marked presence of lipemia in the sample could falsely increase bivalirudin levels.
1. Linkins LA, Dans AL, Moores LK, et al: Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e495S-e530s
2. Love JE, Ferrell C, Chandler WL: Monitoring direct thrombin inhibitors with a plasma diluted thrombin time. Thromb Haemost. 2007 Jul;98(1):234-242
3. Van Cott EM, Roberts AJ, Dager WE: Laboratory Monitoring of Parenteral Direct Thrombin Inhibitors. Semin Thromb Hemost. 2017 Apr;43(3):270-276
4. Gosselin RC, Douxfils J: Ecarin based coagulation testing. Am J Hematol. 2020 Apr;95(6). doi: 10.1002/ajh.25852
5. Gosselin RC, King JH, Janatpour KA, Dager WE, Larkin EC, Owings JT: Comparing direct thrombin inhibitors using aPTT, ecarin clotting times, and thrombin inhibitor management testing. Ann Pharmacother. 2004 Sep;38(9):1383-1388. doi:10.1345/aph.1D565
6. Beyer JT, Lind SE, Fisher S, Trujillo TC, Wempe MF, Kiser TH: Evaluation of intravenous direct thrombin inhibitor monitoring tests: Correlation with plasma concentrations and clinical outcomes in hospitalized patients. J Thromb Thrombolysis. 2020 Feb;49(2):259-267. doi: 10.1007/s11239-019-01961-3
Monday through Friday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
|Test Id||Test Order Name||Order LOINC Value|
|BIVAL||Bivalirudin, Ecarin, P||In Process|
|Result Id||Test Result Name||
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|BIVA1||Bivalirudin, Ecarin, P||In Process|