A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

Cornell, Timothy T.; Wyrick, Polly L.; Fleming, Geoffrey M.; Pasko, Deborah A.; Han, Yong; Custer, Joseph R.; Haft, Jonathan W.; Annich, Gail M.

doi:10.1097/mat.0b013e31805c0d6c

Cited by 26 publications

(28 citation statements)

References 19 publications

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“…Routine monitoring of head ultrasounds did not reveal intracranial hemorrhage in any of the 12 subjects while on bivalirudin. Two subjects had evidence of hemorrhage from chest tubes requiring chest (19)(20)(21)(22)(23)(24). Therefore, clinicians are confronted with the perilous challenge of non-heparin anticoagulation for this complex patient population with minimal evidence or guidance.…”

Section: Resultsmentioning

confidence: 97%

“…There are several cases describing the use of alternative direct thrombin inhibitors (argatroban, lepirudin) during extracorporeal life support including three case reports and one case series using bivalirudin (19)(20)(21)(22)(23)(24). This analysis describes the dosing and monitoring of bivalirudin as an alternative to heparin in pediatric extracorporeal life support patients who developed heparin-induced thrombocytopenia, heparin resistance, or significant thrombosis while on heparin.…”

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confidence: 94%

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Bivalirudin in Pediatric Patients Maintained on Extracorporeal Life Support

Nagle

Dager

Duby

et al. 2013

Pediatric Critical Care Medicine

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This is the largest case series describing the use of a direct thrombin inhibitor in pediatric extracorporeal life support patients. The maintenance dose range reflected considerable inter-patient variability. There was an observed increase in dose requirements with time. Bivalirudin, with close monitoring, is a potential option for pediatric patients on extracorporeal life support who have developed heparin-induced thrombocytopenia, heparin resistance, or significant thrombosis while on heparin.

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Section: Resultsmentioning

confidence: 97%

mentioning

confidence: 94%

Bivalirudin in Pediatric Patients Maintained on Extracorporeal Life Support

Nagle

Dager

Duby

et al. 2013

Pediatric Critical Care Medicine

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“…Cornell published a case series of five adult patients on ECLS without any complications noted. 20 Beiderlinden retrospectively reviewed nine adult patients on ECLS for ARDS being treated with argatroban after a diagnosis of HIT. 21 One critically ill patient had major bleeding and required a dose reduction, thought likely due to impaired hepatic metabolism.…”

Section: Argatrobanmentioning

confidence: 99%

Anticoagulation for Extracorporeal Life Support

Coughlin

Bartlett

2015

ASAIO Journal

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Since its introduction to bedside clinical practice over 40 years ago, extracorporeal life support (ECLS) has been continually changing and improving as a life-saving technology. Extracorporeal life support disrupts the normal finely maintained balance of coagulation and fibrinolysis by exposing large amounts of blood to nonendothelial surfaces. This leads to an inflammatory response with activation of the coagulation cascade and the need for systemic anticoagulation. Unfractionated heparin (UNFH) is currently the standard anticoagulant in ECLS. Alternative anticoagulants have been recently developed with improved safety profiles and reliable monitoring. Within this group of agents are the direct thrombin inhibitors (DTIs) bivalirudin and argatroban. The purpose of this article is to compare these DTIs to the current standard of UNFH anticoagulation during ECLS, to evaluate the current literature surrounding the use of these drugs in ECLS, and finally to propose therapeutic guidelines for their use in ECLS.

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“…Bačić G, Tomulić V, Medved I, Zaputović L, Zaninović Jurjević T, Gobić D lijekom poput direktnih inhibitora trombina bivalirudina ili argatrobana 43 .…”

Section: Complications Related To the Patientunclassified

“…Stope preživljenja bolesnika liječenih V-A ECMO-om zbog kardiogenog šoka, zastoja srca ili nemogućnosti odvajanja od stroja za izvantjelesnu cirkulaciju nakon kardiokirurDue to systemic UFH application, the appearance of heparin-induced thrombocytopenia with concomitant predisposition to thrombosis is a possibility. In such cases, UFH must be replaced by different anticoagulant medication such as direct thrombin inhibitors bivalirudin or argatroban 43 .…”

Section: Rezultati Liječenjamentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Adults

Bačić

Tomulić

Medved

et al. 2017

Cardiologia Croatica

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SAŽETAK: Izvantjelesna membranska oksigenacija (engl. Extracorporeal Membrane Oxygenation, ECMO) postupak je izvantjelesne mehaničke cirkulacijske ili respiracijske potpore koji se primjenjuje primarno u bolesnika sa životno ugrožavajućim oblicima zatajivanja rada srca ili pluća. Dva su osnovna oblika ECMO potpore: vensko-venski (V-V) i vensko-arterijski (V-A) ECMO. V-V ECMO osigurava funkciju izmjene plinova u krvi i primjenjuje se u slučaju teške reverzibilne respiracijske insuficijencije. V-A ECMO podržava funkciju rada srca i pluća, a, osim pri reverzibilnim oblicima oštećenja srčane funkcije, može se rabiti i pri njezinu ireverzibilnom oštećenju, kao premoštenje do transplantacije srca ili ugradnje uređaja za mehaničku cirkulacijsku potporu. ECMO je invazivan i tehnički složen postupak koji se obavlja u kritično bolesnih pa stoga nosi visok rizik od pojave komplikacija. Rezultati liječe-nja ECMO-om razlikuju se ovisno o indikaciji za sam postupak. Bolesnici u kojih je ECMO primijenjen radi respiracijske potpore imaju bolje ishode u usporedbi s onima s kardiogenim šokom ili zastojem srca. Iako nedostaju dokazi temeljeni na velikim randomiziranim studijama koji bi poduprli njegovu primjenu, ECMO je u kliničkoj praksi spasonosna metoda liječenja u dobro odabranih, kritičnih bolesnika. SUMMARY:Extracorporeal membrane oxygenation (ECMO) is a procedure that provides extracorporeal mechanical circulatory or respiratory support and is used primarily in patients with life-threatening forms of heart or respiratory failure. There are two basic types of ECMO support: veno-venous (VV) and veno-arterial (VA) ECMO. VV ECMO ensures blood gas exchange and is applied in cases of severe reversible respiratory insufficiency. VA ECMO supports the function of the heart and lungs; other than in reversible forms of damaged heart function, it can also be used in irreversible forms of heart failure as a bridge to heart transplantation or to the implantation of mechanical circulatory support device. ECMO is an invasive and technically complex procedure that is performed in critically ill patients and thus has a high risk of complications. Results of ECMO treatment vary depending on the indications for the procedure itself. Patients in whom ECMO was applied for respiratory support show better outcomes compared with those with cardiogenic shock or cardiac arrest. Despite a lack of evidence based on large randomized studies to support its application, in clinical practice ECMO represents a life-saving method of treatment in well-selected critical patients.KLJUČNE RIJEČI: izvantjelesna membranska oksigenacija, kardiogeni šok, respiracijska insuficijencija.

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A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

Cited by 26 publications

References 19 publications

Bivalirudin in Pediatric Patients Maintained on Extracorporeal Life Support

Bivalirudin in Pediatric Patients Maintained on Extracorporeal Life Support

Anticoagulation for Extracorporeal Life Support

Extracorporeal Membrane Oxygenation in Adults

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