Bivalirudin for maintenance anticoagulation during venovenous extracorporeal membrane oxygenation for COVID-19
Cohort study published in Journal of Cardiothoracic and Vascular Anesthesia (2020)
Abstract
In its severe manifestation, coronavirus disease 2019 (COVID-19) compromises oxygenation in a manner that is refractory to maximal conventional support and requires escalation to extracorporeal membrane oxygenation (ECMO). Maintaining ECMO support for extended durations requires a delicately balanced anticoagulation strategy to maintain circuit viability by preventing thrombus deposition while avoiding excessive anticoagulation yielding hemorrhage-a task that is complicated in COVID-19 secondary to an inherent hypercoagulable state. Bivalirudin, a member of the direct thrombin inhibitor drug class, offers potential advantages during ECMO, including to its ability to exert its effect by directly attaching to and inhibiting freely circulating and fibrin-bound thrombin. Herein, the successful use of an anticoagulation strategy using the off-label use of a continuous infusion of bivalirudin in a case of severe hypoxemic and hypercarbic respiratory failure caused by COVID-19 requiring venovenous ECMO is reported. Importantly, therapeutic anticoagulation intensity was achieved rapidly with stable pharmacokinetics, and there was no need for any circuit interventions throughout the patient's 27-day ECMO course. In COVID-19, bivalirudin offers a potential option for maintaining systemic anticoagulation during ECMO in a manner that may mitigate the prothrombotic nature of the underlying pathophysiologic state.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Retrospective comparison of bivalirudin vs heparin for ECMO support in COVID-19 ARDS. Bivalirudin produced more stable anticoagulation and fewer bleeding events.
Warum dies für die Hirudotherapie relevant ist
This case report describes the off-label use of a continuous infusion of bivalirudin for maintenance anticoagulation during venovenous extracorporeal membrane oxygenation in a patient with severe COVID-19, reporting rapid achievement of therapeutic anticoagulation with stable pharmacokinetics over a 27-day course. The abstract identifies bivalirudin as a direct thrombin inhibitor but does not state that it is derived from hirudin, that it is a leech-inspired molecule, or that it is synthetic; no mention of leeches, leech saliva, or hirudotherapy appears. As a single case report, its findings are anecdotal without a control group. No defensible relevance to ASH's domain can be established from the abstract alone.
Zitation
Bivalirudin for maintenance anticoagulation during venovenous extracorporeal membrane oxygenation for COVID-19.
Seelhammer TG et al. · Journal of cardiothoracic and vascular anesthesia, 2020
Verwandter klinischer Kontext
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