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Comparison of Bivalirudin Versus Unfractionated Heparin for Anticoagulation in Adult Patients on Extracorporeal Membrane Oxygenation.
- Source :
-
ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2022 Jul 01; Vol. 68 (7), pp. 920-924. Date of Electronic Publication: 2022 Oct 19. - Publication Year :
- 2022
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Abstract
- 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.<br />Competing Interests: Disclosure: The authors have no financial or conflicts of interest to report.<br /> (Copyright © ASAIO 2021.)
- Subjects :
- Adult
Anticoagulants adverse effects
Anticoagulants therapeutic use
Antithrombins therapeutic use
Fibrinolytic Agents therapeutic use
Hemorrhage chemically induced
Hemorrhage complications
Hemorrhage prevention & control
Heparin adverse effects
Heparin therapeutic use
Hirudin Therapy
Hirudins adverse effects
Humans
Peptide Fragments adverse effects
Peptide Fragments therapeutic use
Recombinant Proteins adverse effects
Recombinant Proteins therapeutic use
Retrospective Studies
Treatment Outcome
Extracorporeal Membrane Oxygenation adverse effects
Thrombosis drug therapy
Thrombosis etiology
Thrombosis prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1538-943X
- Volume :
- 68
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- ASAIO journal (American Society for Artificial Internal Organs : 1992)
- Publication Type :
- Academic Journal
- Accession number :
- 34669620
- Full Text :
- https://doi.org/10.1097/MAT.0000000000001598