Therapeutic monitoring

At UWMC, bivalirudin is monitored using the Direct Thrombin Inhibitor (DTI) assay (Plasma-Diluted Thrombin Time).

Used instead of aPTT to monitor injectable DTI therapy. Preferred over aPTT due to better sensitivity, and is not affected by antiphospholipid antibodies. Cost, turn-around time and 24/7 availability at UWMC are similar to aPTT.

  • Therapeutic range for DTIs administered by continuous infusion
    • For argatroban: 60-100 seconds
    • For bivalirudin: 60-90 seconds
    • For lepirudin: 90-160 seconds
  • Test order code: DTI
  • Specimen collection: 3mL or 5mL blue top

Love JE, et al Monitoring direct thrombin inhibitors with a plasma diluted thrombin time. Thromb Haemost. 2007 Jul;98(1):234-42.