| Summary: | Introduction: : Direct thrombin inhibitors are drugs of choice used to prevent thrombotic complications in hospitalized patients after heparin induced thrombocytopenia (HIT) diagnosis. Material and method: : We present a case of bivalirudin resistance in patient undergoing heart transplantation due to dilated cardiomyopathy with confirmation of HIT. Bivalirudin was given intraoperatively as cardiopulmonary bypass circulation was applied. From initial infusion rate of 2.5 mg/kg/hour, up to 4 mg/kg/hour, due to low ACT results. The repeated ACT results were 422s, 452s and 468s on 5 minutes intervals. Conclusion: : Resistance to bivalirudin, though rare, can be overbeared by high bivalirudin dosing under ACT control during surgical procedures including heart transplantation.
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