Adaptive Control of Bivalirudin in the Cardiac Intensive Care Unit

Abstract

Bivalirudin is a direct thrombin inhibitor used in the cardiac intensive care unit in patients who develop an allergic reaction to heparin. Since it is not a commonly used drug, clinical experience with its dosing is sparse. In earlier work (Zhao et al. [2014]) we developed a dynamic system model that accurately predicts the effect of bivalirudin when given dosage over time and patient physiological characteristics. This paper develops adaptive dosage controllers that regulate its effect to desired levels. To that end, and in the case that bivalirudin model parameters are available, we develop a Model Reference Control law. In the case that model parameters are unknown, an indirect Model Reference Adaptive Control scheme is applied to estimate model parameters first and then adapt the controller. Our algorithms are validated using actual data from a large hospital in the Boston area.