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Test Code BIVAL BIVALIRUDIN CONCENTRATION

Specimen and Container/Tube

Specimen Type: Plasma

Preferred Specimen: Light Blue Top Tube, 3.2% Sodium Citrate

Other Acceptable specimens: N/A

Specimen Handling and Transport Instructions

UCMC Onsite Instructions: 

Collect specimen per standard collection procedure and send to laboratory immediately. 

 

NOTE: Once each blue top tube is completely filled, gently invert the sample tube at least five times to ensure complete mixing of the contents.

 

UCMC Offsite and UC MedLab Outreach Instructions: 

  • Collect specimen per standard collection procedure.
  • Once each blue top tube is completely filled, gently invert the sample tube at least five times to ensure complete mixing of the contents.
  • Centrifuge specimens at >2500 x g for 10 minutes at room temperature.
  • Carefully remove plasma from cells using a plastic transfer pipette avoiding buffy coat.
  • Aliquot removed plasma into 2 plastic tubes containing a minimum of 1.0 mL of specimen in each tube.
  • Plasma samples must then be frozen at -20oC.
  • Once solidly frozen, they must be shipped on dry ice. Samples that have thawed in transit will be rejected.

Rejection Criteria

  • Common specimen rejected situations include: incorrect specimen type, insufficient volume, missing or incomplete specimen identifiers, incorrect specimen transport, or specimens outside stability limits. 
  • Specimens that have wrong ratio of blood to anticoagulant (fill volume), clotted or grossly hemolyzed.

Reference Values

 

Test

Age

Sex

Reference Range

N/A

N/A

N/A

N/A

Critical Values

Analyte

Unit

Low

High

Age

N/A

N/A

N/A

N/A

N/A

CPT Codes

85675 

LOINC Codes

74214-8

Volume

Preferred Volume: 2.0 mL

 

Minimum Volume: 1.0 mL

Specimen Stability

Storage Temperature

Stability

Room temperature

4 hours

Refrigerated

not acceptable

Frozen

30 days

Collection Instructions

Collect specimen per standard laboratory collection procedures. 

 

NOTE: Once each blue top tube is completely filled, gently invert the sample tube at least five times to ensure complete mixing of the contents.

Turnaround Time

Turnaround times are relative to the time the specimen is received in the test laboratory. 

STAT Turnaround Time: N/A

 

Routine Turnaround Time: Up to 8 hours

 

Testing Schedule: 7 days a week from 8:00 am to 10:30 pm.

Clinical Indications

Monitoring of bivalirudin anticoagulation intensity.

Methodology

Clotting by dilute Thrombin Time

Synonyms/Keyword Search

Dilute Thrombin Time; Bivalirudin Monitoring

Additional Information

Bivalirudin is often used intra-operatively at high concentrations, with monitoring by the activated clotting time (ACT).

 

Lower dose continuous infusions of bivalirudin should be monitored as follows:

  •  Bivalirudin level by calibrated dilute thrombin time
    • Therapeutic range 0.5 -2.5 microg/mL

References:

Hasan RA et al. Am J Clin Pathol. 2022 Nov 9.

Warkentin et al. Thromb Haemost. 2005. 94:958

Colucci G et al. J Transl Sci. 2015. 1:37

 

When baseline aPTT is normal, bivalirudin can be monitored using prolongation of aPTT. Of note, aPTT generally shows poor correlation with bivalirudin plasma levels.  If the aPTT is used for bivalirudin monitoring, a typical goal is 1.5-3.0 times baseline aPTT value (Hasan RA et al. Am J Clin Pathol. 2022 Nov 9)

 

This test was validated by the University of Chicago Medicine Coagulation Laboratory. This test has not been cleared or approved by the FDA. The laboratory is regulated under CLIA as qualified to perform high-complexity testing.

 

All 3.2% sodium citrate light blue top tubes must have 9 to 1 ratio of blood to anticoagulant.

Last Review Date

03/13/2024