Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 17, Number 6, June 2026, pages 285-291

Bivalirudin for Recurrent Pediatric Venous Thromboembolism: A Case Report of Heparin Resistance and Thrombectomy

Figures

↓  Figure 1. Computed tomography of the chest. Arrow points to one of many pulmonary emboli.
Figure 1.
↓  Figure 2. Fluoroscopic image from interventional radiology showing thrombotic occlusion of the internal iliac vein.
Figure 2.
↓  Figure 3. Timeline depicting the hospital course. Key events include initiation of UFH with subtherapeutic anticoagulation, clinical worsening with increased clot burden, two mechanical thrombectomies, and transition to bivalirudin.
Figure 3.
↓  Figure 4. Schematic comparison of anticoagulant mechanisms for UFH and bivalirudin. UFH activates antithrombin III to inhibit factors XIIa, XIa, IXa, Xa, and thrombin (IIa), while bivalirudin directly inhibits thrombin independent of antithrombin III.
Figure 4.