Bivalirudin Superior to Heparin for Extracorporeal Membrane Oxygenation: Not So Fast

Abstract

e1057found that PPE could reduce the odds of contracting coronavirus infection. It is an attempt trying to shed light on this important question based on the best evidence that we could gather from the literature. Although the consequence of contracting COVID-19 could be severe, we should err on the safe side until higher level of evidence arises.

The authors reply

“…The critique of the allogeneic transfusion outcome by Mazzeffi et al (1) is valid and was a concern of our research team. To account for potential differences in practice, we elected to also evaluate major bleeding events, using the extracorporeal life support organization definition, which also favored the use of bivalirudin (40.7% in UFH group vs 11.7% in bivalirudin group, p < 0.001).…”

“…W e thank Mazzeffi et al (1) for their remarks and commentaries on our article (2) published recently in Critical Care Medicine.…”

Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement

“…Although bivalirudin can be considered as a good alternative to heparin for anticoagulation during ECMO, its superiority has not been shown; further, there are no data on bivalirudin anticoagulation in children supported with ECMO after HCT. 108,109 Coagulation management among paediatric patients having HCT receiving ECMO is challenging compared with the general PICU population. Thus, the panel strongly agreed that anticoagulation during ECMO should be accurately tailored in patients receiving HCT, balancing both the risks of bleeding and thrombosis.…”

Coagulation and Transfusion Updates From 2021

“…77 Although intriguing, this study had multiple limitations, including a lack of adjustment for confounding by the year of treatment. 78 In the early study period, heparin was used preferentially, and there was a shift to bivalirudin over time. It is likely that ECMO practices and PBM improved in the authors' center over time, and this coincided with the change from heparin to bivalirudin.…”

“…It is likely that ECMO practices and PBM improved in the authors' center over time, and this coincided with the change from heparin to bivalirudin. 78 Another noteworthy study related to anticoagulation during ECMO was a systematic review from Willems et al in which anti-Xa monitoring was compared with ACT and activated partial thromboplastin time monitoring in more than 2,000 patients who received heparin anticoagulation. In this study, patients who had anti-Xa monitoring had a 51% lower odds of having a bleeding complication during ECMO (OR = 0.49), and also significantly lower mortality (OR = 0.61).…”