Perioperative Management

• Decision making regarding whether anticoagulation needs to be held depends on type of surgery and balance of bleeding versus thrombosis risk. If it is indicated, bivalirudin should be held for 2 hours prior to procedure for complete reversal. Alternatively, can decrease infusion rate to 0.1 mg/kg/hr for 30 minutes prior to procedure.
• Restart bivalirudin infusion after the procedure as soon as adequate hemostasis has been established and once cleared by the surgeon or interventionist.