Heparin-based versus bivalirudin-based anticoagulation in pediatric extracorporeal membrane oxygenation: A systematic review
Valdes CA, Sharaf OM, Bleiweis MS, Jacobs JP, Mumtaz M, Sharaf RM, Jeng EI, Peek GJ (2023) · Frontiers in Medicine · n=313
Studienprofil
- Design
- systematic review of seven retrospective cohort studies (PubMed, Cochrane Library, Embase through October 2022)
- Stichprobengröße (n)
- 313
- Intervention
- Bivalirudin anticoagulation in pediatric ECMO (n=117 pooled)
- Komparator
- Heparin anticoagulation in pediatric ECMO (n=196 pooled)
- Primärer Endpunkt
- Bleeding events, thrombotic complications, transfusion requirements, mortality
- Primäres Ergebnis
- Bivalirudin trended toward lower bleeding, transfusion requirements, and thrombosis; no mortality difference; bivalirudin associated with lower overall costs; time to therapeutic anticoagulation variable between studies
- Follow-up-Dauer
- ECMO run + hospital course
- PMID
- 36999064
Wichtigste Ergebnisse
- Pediatric-specific pooled analysis (n=313) of bivalirudin vs heparin
- Trends toward lower bleeding and thrombosis with bivalirudin
- Lower transfusion requirements with bivalirudin
- Lower overall pharmacologic costs with bivalirudin
- No mortality signal in either direction
Einschränkungen
- All 7 included studies retrospective
- Heterogeneous anticoagulation targets across institutions
- Small sample sizes in individual studies
- Cannot adjust for unmeasured confounders
- Not applicable to whole-leech hirudotherapy
Klinische Implikationen
Valdes 2023 provides a pediatric-specific evidence summary supporting bivalirudin as a feasible heparin alternative in children on ECMO. For ASH, the systematic review confirms the pediatric pharmaceutical pathway operates under retrospective signal-generation distinct from device-leech K040187 US clinical practice. The cost-effectiveness signal supports pharmaceutical pathway scaling under specific clinical scenarios.
Verwandte Studien
Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Neonatal and Pediatric Extracorporeal Membrane Oxygenation
McMichael A, Weller J, Li X, Hatton L, Zia A, Raman L (2024)
Efficacy of Bivalirudin for Therapeutic Anticoagulation in COVID-19 Patients Requiring ECMO Support
Trigonis R, Smith N, Porter S, Anderson E, Jennings M, Kapoor R, Hage C, Moiz S, Garcia J, Rahman O (2021)
Bivalirudin versus heparin anticoagulation in patients receiving extracorporeal membrane oxygenation
Huang D, Guan Q, Qin J, Shan R, Wu J, Zhang C (2022)
Comparison of Bivalirudin Versus Heparin for Anticoagulation During Extracorporeal Membrane Oxygenation
Hasegawa D, Sato R, Prasitlumkum N, Nishida K, Keaton B, Acquah SO, Im Lee Y (2022)