Evaluation of a Bivalirudin Dosing and Monitoring Protocol in Pediatric Extracorporeal Membrane Oxygenation
Retrospective protocol evaluation published in J Pediatr Pharmacol Ther (2025)
Abstract
OBJECTIVE: Bivalirudin is a direct thrombin inhibitor used off-label for systemic anticoagulation in extracorporeal membrane oxygenation (ECMO). There are limited data available in pediatric patients, specifically regarding optimal dosing in this heterogeneous population of patients. This study aimed to characterize bivalirudin use in pediatric patients on ECMO at a single center. METHODS: A retrospective chart review was conducted for consecutive patients undergoing ECMO at a quaternary center between January 2021 and June 2023 who received bivalirudin as the primary anticoagulation agent. The primary outcome was the dose of bivalirudin required to achieve activated partial thromboplastin time (aPTT) in the goal range. Additionally, time in therapeutic range, time to initial aPTT goal, dose adjustments required in patients receiving renal replacement therapy, amount of blood and blood products received, incidence of major bleeding, and complete ECMO circuit changes were evaluated. RESULTS: Fourteen patients, including 6 neonates, 5 children, and 3 adolescents, were included in the study. Eleven patients were initially placed on venoarterial ECMO, and 3 were initially placed on venovenous ECMO. The median ECMO duration was 6 days. The median dose of bivalirudin required to achieve the initial goal aPTT level varied between neonates, children, and adolescents (0.1 mg/kg/hr, 0.2 mg/kg/hr, 0.05 mg/kg/hr, respectively). CONCLUSIONS: Multiple patient factors including age, indication for ECMO, renal function, and hepatic function must be taken into consideration when determining a starting dose of bivalirudin for these pediatric patients.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Bivalirudin doses for aPTT goal range varied between 14 ECMO patients (neonates 0.1, children 0.2, adolescents 0.05 mg/kg/hr); age, indication, renal/hepatic function influenced dosing.
Warum dies für die Hirudotherapie relevant ist
This retrospective chart review characterized bivalirudin use—a direct thrombin inhibitor used off-label for systemic anticoagulation in ECMO—in 14 pediatric patients on ECMO at a single quaternary center between January 2021 and June 2023. The primary outcome was the dose required to achieve goal activated partial thromboplastin time, with secondary measures including time in therapeutic range, bleeding events, and circuit changes. The authors found that median doses varied substantially by age group—0.1 mg/kg/hr for neonates, 0.2 mg/kg/hr for children, and 0.05 mg/kg/hr for adolescents—emphasizing the need to account for patient-specific factors including age, renal function, and hepatic function when dosing. The abstract does not mention hirudin, leeches, or any leech-derived compound, so no defensible hirudotherapy link exists. This is a small single-center retrospective review without a comparator group and does not involve leeches or hirudotherapy.
Zitation
Evaluation of a Bivalirudin Dosing and Monitoring Protocol in Pediatric Extracorporeal Membrane Oxygenation.
Smith LM et al. · The journal of pediatric pharmacology and therapeutics, 2025
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