Is anticoagulation with bivalirudin comparable to heparin for pediatric extracorporeal life support? Results from a high-volume center.
Adolescent
Anticoagulants
/ administration & dosage
Blood Coagulation
/ drug effects
Child
Child, Preschool
Critical Illness
/ therapy
Drug Substitution
/ statistics & numerical data
Extracorporeal Membrane Oxygenation
/ adverse effects
Female
Hemorrhage
/ chemically induced
Heparin
/ administration & dosage
Hirudins
/ administration & dosage
Hospitals, High-Volume
/ statistics & numerical data
Humans
Infant
Intensive Care Units, Pediatric
/ statistics & numerical data
Male
Peptide Fragments
/ administration & dosage
Recombinant Proteins
/ administration & dosage
Retrospective Studies
Stroke
/ epidemiology
Thrombosis
/ epidemiology
anticoagulation
bivalirudin
extracorporeal life support
pediatric
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
04
03
2020
revised:
04
06
2020
accepted:
12
06
2020
pubmed:
20
6
2020
medline:
28
9
2021
entrez:
20
6
2020
Statut:
ppublish
Résumé
There is a paucity of data regarding the use of direct thrombin inhibitors such as bivalirudin for children on extracorporeal life support (ECLS). We sought to compare the outcomes of children on ECLS anticoagulated with bivalirudin versus heparin. Patients transitioned from heparin to bivalirudin were treated as a separate group. A single-institution, retrospective review of all consecutive children (neonate to 18 years) placed on ECLS in the cardiac or pediatric intensive care units was performed (June 2018-December 2019). Data collected included demographics, anticoagulation strategy, number of circuit interventions, blood product use on ECLS, survival to decannulation, and survival to discharge. Fifty-four children were placed on ECLS for a total of 56 runs. Demographics and venovenous versus venoarterial ECLS were similar. The bivalirudin group had longer median duration of support compared to the heparin group--11.0 days [IQR 6.2, 23.1] versus 3.3 days [2.1, 6.2], P < .001. Patients switched from heparin to bivalirudin had a similar duration of support (10.3 days [8.3, 18.3]) as those on bilvalirudin alone. However, there was no difference in red blood cell, fresh frozen plasma, or platelet transfusions. There was no difference in the number of circuit interventions, survival to decannulation or discharge. The freedom to first circuit intervention was longer with bivalirudin compared to heparin. Our data suggest that even with longer pediatric ECLS runs on bivalirudin, there were no differences in the outcomes between the heparin and bivalirudin groups, with longer freedom from first circuit intervention with bivalirudin. While this is the largest reported series comparing children on ECLS anticoagulated with heparin versus bivalirudin, larger studies are needed to determine the optimal anticoagulation strategy for this diverse and complicated group of children.
Substances chimiques
Anticoagulants
0
Hirudins
0
Peptide Fragments
0
Recombinant Proteins
0
Heparin
9005-49-6
bivalirudin
TN9BEX005G
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
15-21Informations de copyright
© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.
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