Comparison of Bivalirudin Versus Unfractionated Heparin for Anticoagulation in Adult Patients on Extracorporeal Membrane Oxygenation.
Adult
Anticoagulants
/ adverse effects
Antithrombins
/ therapeutic use
Extracorporeal Membrane Oxygenation
/ adverse effects
Fibrinolytic Agents
/ therapeutic use
Hemorrhage
/ chemically induced
Heparin
/ adverse effects
Hirudin Therapy
Hirudins
/ adverse effects
Humans
Peptide Fragments
/ adverse effects
Recombinant Proteins
/ adverse effects
Retrospective Studies
Thrombosis
/ drug therapy
Treatment Outcome
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
pubmed:
21
10
2021
medline:
1
7
2022
entrez:
20
10
2021
Statut:
ppublish
Résumé
Extracorporeal membrane oxygenation (ECMO) contributes to coagulopathy, necessitating systemic anticoagulation to prevent thrombosis. Traditionally, unfractionated heparin (UFH) has been the anticoagulant of choice, however, due to many inadequacies new evidence suggests benefit with the use of direct thrombin inhibitors. This retrospective cohort sought to evaluate the safety and efficacy of bivalirudin compared to UFH in ECMO patients. Primary endpoints included incidence of bleeding and thrombosis. Percent time in therapeutic range (TR), time to achieve TR and number of dose titrations required to maintain TR were calculated to assess efficacy of institutional protocols. Overall incidence of thrombosis was low, with one event in the bivalirudin group and no events in the UFH group. No difference was found in rates of bleeding between groups (6% vs . 10%, P = 0.44). Bivalirudin yielded higher percent time in TR (86% vs. 33%, P < 0.001), faster time to TR (2 vs . 18 hr, P < 0.001) and required fewer dose adjustments to maintain TR (2 vs . 11, P < 0.001) compared to UFH. These results suggest bivalirudin and UFH are associated with similar rates of bleeding and thrombosis in patients requiring ECMO support. Our results demonstrate the favorable pharmacokinetic profile of bivalirudin, and its ability to consistently maintain TR when compared to UFH.
Identifiants
pubmed: 34669620
doi: 10.1097/MAT.0000000000001598
pii: 00002480-202207000-00007
doi:
Substances chimiques
Anticoagulants
0
Antithrombins
0
Fibrinolytic Agents
0
Hirudins
0
Peptide Fragments
0
Recombinant Proteins
0
Heparin
9005-49-6
bivalirudin
TN9BEX005G
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
920-924Informations de copyright
Copyright © ASAIO 2021.
Déclaration de conflit d'intérêts
Disclosure: The authors have no financial or conflicts of interest to report.
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