Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review

Sanfilippo, Filippo; Asmussen, Sven; Maybauer, Dirk M.; Santonocito, Cristina; Fraser, John F.; Erdoes, Gabor; Maybauer, Marc O.

doi:10.1177/0885066616656333

Cited by 129 publications

(117 citation statements)

References 40 publications

(64 reference statements)

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“…Furthermore, thrombocytopenia is prevalent in ECMO patients, and distinguishing between HIT and other causes (eg, platelet activation or excessive bleeding) can be challenging. Another conceivable situation that may limit the use of heparin anticoagulation in conjunction with ECMO is the occurrence of heparin resistance, typically caused by a consumptive deficiency of antithrombin III (AT III) 2 . Bivalirudin, a parenteral direct thrombin inhibitor, is an alternative approach for anticoagulation in patients on ECMO support.…”

Section: Introductionmentioning

confidence: 99%

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

et al. 2020

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Background Extracorporeal membrane oxygenation (ECMO) induces hemostatic alterations that may contribute to hematological complications. Unfractionated heparin (UFH) is the mainstay antithrombotic in ECMO and depends on antithrombin III (AT III) to exhibit its actions. However, it bears the risk for heparin‐induced thrombocytopenia. Bivalirudin is a direct thrombin inhibitor and is inherently not dependent on AT III. Aim of the Study To assess the efficacy and safety profiles of UFH compared with bivalirudin during ECMO support. Methods We retrospectively reviewed 52 adult patients who were supported by ECMO from 1 January 2013 to 1 September 2018. Among them, 33 received UFH and 19 received bivalirudin. We analyzed their 7‐day rate of composite thrombotic, bleeding, and mortality episodes while on anticoagulation. Results There were no statistical differences in the 7‐day rate of composite thrombosis (33.3% vs 26.3%; P = 0.60), major bleeding (18.2% vs 5.3%; P = .24), 30‐day mortality, (42.4% vs 26.3%; P = .37), or in‐hospital mortality (45.5% vs 36.8%; P = .58). The percentage of time activated partial thromboplastin time (aPTT) was within the therapeutic range was higher with bivalirudin (50% vs 85.7%; P = .007). Conclusions This study suggests that UFH and bivalirudin are associated with similar rates of thrombosis, major bleeding, and mortality events in patients supported by ECMO. However, it was observed that bivalirudin consistently maintained aPTT within the therapeutic range in comparison to UFH.

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Section: Introductionmentioning

confidence: 99%

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

et al. 2020

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“…Although direct thrombin inhibitors such as bivalirudin and argatroban are the preferred agents in cases of suspected or confirmed HIT, there is increasing interest in their use as the primary anticoagulant in patients receiving ECLS. They do not carry a risk of HIT, and observational data in patients receiving bivalirudin suggested a more predictable anticoagulant effect and fewer blood transfusions compared with heparin . Limitations of these agents include the lack of a reversal agent and the increased cost compared with unfractionated heparin.…”

Section: Specific Ecls Management Considerationsmentioning

confidence: 99%

Ventilatory and Pharmacotherapeutic Strategies for Management of Adult Patients on Extracorporeal Life Support

et al. 2019

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Extracorporeal life support (ECLS) can provide mechanical support for patients with severe life‐threatening cardiac or respiratory failure. ECLS is a complex therapy that has increased in use over several decades owing to advances in technology. In concert with this growth, there is an increased need to understand the complexity of this technology to augment the effectiveness of ECLS and minimize complications such as ventilator‐induced lung injury, bleeding, thrombosis, infections, and inadequate drug dosing. The purpose of this review was to discuss management strategies in adult patients receiving ECLS and provide recommendations on ventilator management, provision of adequate analgesia and sedation, treatment and prevention of infections, and anticoagulation.

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“…Unfractionated heparin is widely used as the anticoagulant for ECMO patients although potential complications including bleeding, heparin-induced thrombocytopenia, and tachyphylaxis, may arise. 40 Bivalirudin, a direct thrombin inhibitor, has been tested in ECMO patients as an alternative to heparin 41 and been shown to cause less bleeding, be more cost-effective, and results in the need for fewer allogenic transfusions.…”

Section: Anticoagulationmentioning

confidence: 99%

Clinical use of venovenous extracorporeal membrane oxygenation

Ng¹,

Yuen²,

Sin³

et al. 2017

Hong Kong Med J

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Extracorporeal membrane oxygenation has been used clinically for more than 40 years. The technique provides respiratory and/or circulatory support via venovenous and veno-arterial configurations, respectively. We review the basic physiological principles of extracorporeal membrane oxygenation systems in venovenous extracorporeal membrane oxygenation. Clinical aspects including patient selection, equipment, setup, and specific patient management are outlined. Pros and cons of the use of extracorporeal membrane oxygenation in respiratory failure are discussed.

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Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review

Abstract: Bivalirudin loading dose was not always used; infusion range and anticoagulation targets were different. In this systematic review, we discuss the reasons for this variability. Larger studies are needed to establish the optimal approach with the use of bivalirudin for ECMO.

Cited by 129 publications

References 40 publications

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

Ventilatory and Pharmacotherapeutic Strategies for Management of Adult Patients on Extracorporeal Life Support

Clinical use of venovenous extracorporeal membrane oxygenation

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