I have seen papers showing bivalirudin as a valid and safe alternative to heparin during CPB in case of patients with HIT or confirmed protamine allergy: I was wondering if some center is using it regularly.
Bivalirudin (Angiomax) can be used in cardiopulmonary bypass in patients who are heparin compromised due to HIT. However, one should be mindful that there are no specific antidotes available. For monitoring Bivalirudin anticoagulant effects, although APTT assay may be used but a better test is Ecarin Clotting Time.