Intracardiac Clots Masked by Extracorporeal Membrane Oxygenation Venous Cannula

Grimaldi, Antonio; Ajello, Silvia; Scandroglio, Mara; Melisurgo, Giulio; Gardini, Chiara; Bonis, Michele De; Bove, Tiziana; Calabrò, Maria Grazia; Maj, Giulia; Zangrillo, Alberto; Pappalardo, Federico

doi:10.1053/j.jvca.2011.10.007

Cited by 3 publications

(3 citation statements)

References 4 publications

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Section: Discussionmentioning

confidence: 99%

“…Intracardiac thrombus formation during ECMO with heparin anticoagulation has been described as well, but the pharmacokinetic properties of heparin (half-life: 1-2 hours) may limit the risk of thrombus formation due to blood stagnation. 38 Pappalardo and colleagues 29 reported on a patient with acute HIT who underwent ECMO with a heparin-coated system and bivalirudin infusion. In this patient, the HIT reaction continued with concomitant thromboembolic event despite systemic anticoagulation, and this was interpreted as caused by the release of heparin from the circuit.…”

Section: Bivalirudin and Thrombosismentioning

confidence: 99%

See 1 more Smart Citation

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

Sanfilippo

Asmussen

Maybauer

et al. 2016

J Intensive Care Med

128

105

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Section: Discussionmentioning

confidence: 99%

Section: Bivalirudin and Thrombosismentioning

confidence: 99%

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

Sanfilippo

Asmussen

Maybauer

et al. 2016

J Intensive Care Med

128

105

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show abstract

“…Intracardiac thrombus formation during ECMO with heparin anticoagulation has been described as well [5], but the pharmacokinetic properties of heparin may limit the risk of thrombus formation due to blood stagnation.…”

mentioning

confidence: 99%

Bivalirudin and post-cardiotomy ECMO: a word of caution

Ranucci

2012

Crit Care

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Evaluation of Systemic Heparin Versus Bivalirudin in Adult Patients Supported by Extracorporeal Membrane Oxygenation

et al. 2018

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Systemic anticoagulation is a standard of care in adult patients supported by extracorporeal membrane oxygenation (ECMO) to prevent circuit thrombosis and subsequent thromboembolic events. Unfractionated heparin has long been considered the anticoagulant of choice, but emerging evidence reports successful ECMO runs with direct thrombin inhibitors. This retrospective study sought to determine whether bivalirudin offers distinct clinical benefits as the anticoagulant of choice in ECMO. Primary end points included thrombotic events during the initial 96 hours of anticoagulation, over the course of their entire ECMO run, and at any time during the admission, as well as in-hospital and 30-day mortality. Secondary end points included percent time within therapeutic range for each anticoagulant, neurologic events, vascular complications, and bleeding. Compared with patients receiving heparin, patients receiving bivalirudin show similar rates of thrombotic events across the three time points (17.9% vs. 9.1%; p = 0.47, 21.4% vs. 11.4%; p = 0.41, and 25% vs. 22.7%; p = 1.00, respectively). In-hospital (32.1% vs. 36.4%; p = 0.91) and 30-day mortality (32.1% vs. 36.4%; p = 0.91) were no different. Similarly, no differences were observed in percent time within therapeutic range (83.0% vs. 87.7%, p = 0.34), neurological events (7.1% vs. 11.4%, p = 0.99), vascular complications (57.1% vs. 38.6%, p = 0.20), or major (25.0% vs. 45.5%, p = 0.13) and minor (25.0% vs. 22.7%, p = 1.00) bleeding. These results suggest that bivalirudin is a viable alternative to heparin for anticoagulation in ECMO but may not offer a clinically significant advantage as the anticoagulant of choice.

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Intracardiac Clots Masked by Extracorporeal Membrane Oxygenation Venous Cannula

Cited by 3 publications

References 4 publications

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

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

Bivalirudin and post-cardiotomy ECMO: a word of caution

Evaluation of Systemic Heparin Versus Bivalirudin in Adult Patients Supported by Extracorporeal Membrane Oxygenation

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