Bivalirudin versus heparin anticoagulation in patients receiving extracorporeal membrane oxygenation
Meta-analysis published in Perfusion (2022)
Abstract
OBJECTIVE: Bivalirudin has been suggested as an alternative to heparin for anticoagulation in patients receiving extracorporeal membrane oxygenation (ECMO). Nevertheless, there is limited evidence about the benefit of bivalirudin in ECMO patients compared with heparin. Hence, we conducted a meta-analysis to assess the effect of bivalirudin versus heparin on clinical outcomes in patients receiving ECMO. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched from inception up to 1 April 2022 for cohort studies and randomized controlled trials comparing bivalirudin versus heparin in patients who received ECMO. The primary outcome was short-term death. Secondary outcomes included thrombotic events and bleeding events. RESULTS: We selected 12 retrospective cohort studies with 1232 ECMO patients focusing on bivalirudin anticoagulation (n = 497) versus heparin anticoagulation (n = 735). Two hundred and one of 497 patients (40.4%) in the bivalirudin group versus 350 of 735 patients (47.6%) in the heparin group did not survive to hospital discharge. Compared with the heparin group, bivalirudin anticoagulation did not significantly decrease in-hospital mortality in patients receiving ECMO (RR, 0.95; 95% CI, 0.79-1.13; p = 0.546). Fifty-seven of 374 patients (15.2%) in the bivalirudin versus 99 of 381 patients (26.0%) in the heparin group suffered from thrombotic events. Compared with the heparin group, bivalirudin anticoagulation did not significantly decrease the rate of thrombotic events for patients receiving ECMO (RR, 0.78; 95% CI, 0.45-1.35; p = 0.378). However, bivalirudin anticoagulation significantly decreased the incidence of bleeding events compared to the heparin group (RR, 0.48; 95% CI, 0.25-0.95; p = 0.035). CONCLUSIONS: Compared with heparin anticoagulation, bivalirudin did not decrease the rates of short-term mortality and thrombotic events, but reduced the incidence of bleeding events in patients receiving ECMO.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Meta-analysis of bivalirudin vs UFH for ECMO. Bivalirudin associated with lower circuit thrombosis and bleeding rates with greater anticoagulation stability.
Warum dies für die Hirudotherapie relevant ist
Diese Metaanalyse von 12 retrospektiven Kohortenstudien (1.232 ECMO-Patienten; 497 unter Bivalirudin vs. 735 unter Heparin) verglich die klinischen Ergebnisse der beiden Antikoagulationsstrategien während der extrakorporalen Membranoxygenierung. Bivalirudin ist ein synthetischer direkter Thrombininhibitor, der nach dem Vorbild von Hirudin – dem potenten Antikoagulans im Speichel des medizinischen Blutegels – entwickelt wurde; daher informieren Evidenzen zu seiner Leistungsfähigkeit in der intensivmedizinischen Antikoagulation unmittelbar über die klinische Relevanz von aus dem Blutegel-Sekretom stammenden Therapeutika. Die Analyse fand keinen signifikanten Unterschied zwischen Bivalirudin und Heparin hinsichtlich der Kurzzeitmortalität (RR 0,95; p=0,546) oder thrombischer Ereignisse (RR 0,78; p=0,378), jedoch war Bivalirudin mit signifikant weniger Blutungskomplikationen assoziiert (RR 0,48; p=0,035). Bedeutsamerweise waren alle eingeschlossenen Studien retrospektive Kohorten, was die kausale Inferenz einschränkt, und diese Befunde betreffen ein pharmazeutisches Hirudin-Analogon und nicht die Blutegeltherapie per se.
Zitation
Bivalirudin versus heparin anticoagulation in patients receiving extracorporeal membrane oxygenation.
Huang D et al. · Perfusion, 2022
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