Is bivalirudin an alternative anticoagulant for extracorporeal membrane oxygenation (ECMO) patients? A systematic review and meta-analysis
Li DH, Sun MW, Zhang JC, Zhang C, Deng L, Jiang H (2021) · Thrombosis Research · n=0
Studienprofil
- Design
- systematic review and meta-analysis of 10 studies (9 in meta-analysis): RCTs, cohort, and case-control studies
- Stichprobengröße (n)
- —
- Intervention
- Bivalirudin anticoagulation for ECMO
- Komparator
- Heparin anticoagulation for ECMO
- Primärer Endpunkt
- Hospital mortality, ECMO duration, major bleeding, thrombosis, circuit interventions
- Primäres Ergebnis
- In adults, bivalirudin associated with lower hospital mortality (OR 0.65, 95% CI 0.44-0.95, p=0.03) and lower thrombosis (OR 0.55, 95% CI 0.37-0.83, p=0.004); no significant differences in major bleeding, ECMO duration, or circuit interventions
- Follow-up-Dauer
- Hospital discharge
- PMID
- 35007937
Wichtigste Ergebnisse
- 35% relative reduction in hospital mortality with bivalirudin in adults
- 45% relative reduction in thrombotic events
- No difference in bleeding, ECMO duration, or circuit interventions
- Authors transparent about low evidence quality
- Complements parallel meta-analyses from Hasegawa, Huang, Wieruszewski
Einschränkungen
- All 10 included studies retrospective observational
- Significant heterogeneity could not be eliminated
- Authors explicitly note low overall evidence level
- Lack of standardization in anticoagulation targets
- Not applicable to whole-leech hirudotherapy
Klinische Implikationen
Li 2021 provides early systematic review evidence supporting bivalirudin survival and thrombosis benefits in adult ECMO, consistent with parallel syntheses. For ASH, this work demonstrates how aggregated retrospective observational evidence builds the case for the synthetic thrombin inhibitor pharmaceutical pathway, structurally separate from the K040187 device-leech US clinical practice. The author transparency about evidence quality models good methodological practice.
Verwandte Studien
Hirulog in the treatment of unstable angina. Results of the Thrombin Inhibition in Myocardial Ischemia (TIMI) 7 trial
Fuchs J, Cannon CP (1995)
Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial
Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Wong SC, Nikolsky E, Gambone L, Vandertie L, Parise H, Dangas GD, Stone GW (2009)
Experience with pharmacologic leeching with bivalirudin for adjunct treatment of venous congestion of head and neck reconstructive flaps
Harun A, Kruer RM, Lee A, Boahene K, Byrne PJ, Richmon JD (2018)
Heparin and Bivalirudin in Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Review Article
Wang G, Qi K, Li X, Zuo S, Zhang R, Zhao Y, Sun S, Zhang J, Liu X (2024)