Heparin Versus Bivalirudin for Anticoagulation in Adult Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Wieruszewski PM, Macielak SA, Nei SD, Moman RN, Seelhammer TG, Nabzdyk CGS, Gerberi DJ, Mara KC, Hooten WM, Wittwer ED (2022) · ASAIO Journal · n=0
Studienprofil
- Design
- systematic review and meta-analysis of 6 retrospective observational studies (5 meta-analyzable)
- Stichprobengröße (n)
- —
- Intervention
- Bivalirudin anticoagulation in adult ECMO
- Komparator
- Heparin anticoagulation in adult ECMO
- Primärer Endpunkt
- Circuit-related thrombosis, mortality, major bleeding events
- Primäres Ergebnis
- Heparin associated with more circuit-related thrombosis (OR 2.05, 95% CI 1.25-3.37, p=0.005) and higher mortality (OR 1.62, 95% CI 1.19-2.21, p=0.002) vs bivalirudin; no significant difference in major bleeding (OR 1.83, p=0.33)
- Follow-up-Dauer
- ECMO run + hospital discharge
- PMID
- 36355803
Wichtigste Ergebnisse
- Mayo Clinic-led methodologically rigorous synthesis
- Heparin associated with 2-fold higher circuit thrombosis vs bivalirudin
- 62% higher mortality signal with heparin
- No significant difference in major bleeding events
- Uses ROBINS-I risk-of-bias tool for transparency
Einschränkungen
- All 6 studies retrospective observational
- Significant heterogeneity in bleeding endpoint (I²=82.7%)
- Patient selection bias likely
- Confidence intervals broad for some outcomes
- Not applicable to whole-leech hirudotherapy
Klinische Implikationen
Wieruszewski 2022 contributes adult-specific evidence to the bivalirudin ECMO landscape. For ASH, this meta-analysis demonstrates how rigorous methodology applied to retrospective data can produce robust signals for the synthetic thrombin inhibitor pathway, distinct from the K040187 device-leech US clinical practice. The thrombosis and mortality signals strengthen the case for prospective RCT confirmation.
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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)
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)